Psych Patients Receiving Poor Care in the ER

whodunit · Jan 17, 2009

I agree, and its almost as bad after they are on the unit.You have to get aggresive to even get medical on call docs up to the unit at times and then they play pass the buck for several days before any decision is made.What about first, do no harm?,neglect is just that in my book !

Jules A, MSN · Jan 17, 2009

What a shame. Many EDs in my area now have a special psych pod which I think should be standard. I'm sure your facility does this also but we have a strict policy requiring labs and medical clearance before we will agree to admit which helps although there are still times when they try to slip on in on us.

SuperPsychdRN · Jan 17, 2009

Yes, we also have strict medical clearance guidelines before admitting and they also try slipping them by us too.

whodunit · Jan 17, 2009

yeah we have crisis intervention pods set up in the ER and labs etc are done before admission{some of the time, others the docs say we can do on the unit}.Our biggest problem is getting them taken care of after they've been on the floor awhile and need something.Ex.pt admitted for detox,5 days later,chokes while eating cracker, got swallowing assessment done,ordered npo, 2 days later baruimswallow done, pt shows aspiration everywhere, kept npo with orders for 1 bag fluids given. 2 days later, we nurses are raising cain cause still no meds/food/fluids, they finally order Peg tube.Psych doc says admit to medical floor{pt no longer meets criteria for our floor,} medical dr twiddles thumbs, does not release him 2 more days Arggggg !

inthesky · Jan 18, 2009

My hospital has a special psych annex, but we do sometimes get straight admits from the ED and they are horrible! About a year ago, a psych patient actually died of sepsis in the waiting room! We get patients who have no labs or not sufficient labs and we get them to our unit and discover mags of below 1.3 and Ks of 3.0..no replacement of course. We get patients who went to the ED for actual medical reasons and are bullied into signing in for psych. :banghead:

nkochrn, RN · Jan 21, 2009

HOW SAD!!! I actually have some issues with an ER frequenter. He has had every test imaginable done I think and seen every kind of specialist there is. He said he went to a mental treatment facility, they put him on meds and it didn't make a difference. There is no way that he stayed anywhere long enough to be properly treated because he doesn't want to admit that he has a mental problem. I'm fairly certain he is bipolar. We just don't know what to do with him anymore. He comes to the ER several times a week, sometimes several times a day with the same complaints, but no one can find anything wrong with him.

MADHAT6 · Jan 21, 2009

i am a psych nurse and my job is to liaison between the ER and the psych unit,and to send people without insurance to the state hospitals,i agree with what you are saying but now that i float to the ER i see what chaos they are in...in our state,North Carolina,the mental health system has been dismantled so all the clients that used to go to the mental health center for triage and meds come to the ER,as well as all the substance abusers,all the involuntary committments,all the adolescents who are causing problems,people who are grief struck by loss of their pets etc,as well as all the psychotic,homocidal,suicidal and delusional and manic...the ER is overwhelmed ! they have about 160,000 visits a year anyway and now the mental health clients from 3 counties have nowhere to go except the ER...DOES IT EXCUSE POOR CARE...NOT AT ALL...but now i am seeing what they are dealing with i am suprised they do as well as they do:yawn: they are exhausted!

Whispera, MSN, RN · Jan 21, 2009

I worked as a psych/ER liaison for awhile. While the ER I dealt with was usually pretty good, I did find suicidal patients alone in exam rooms, around the corner from staff where no one would see them, with bags of pills or weapons beside them. When working on the psych unit, there were times when patients were brought to us with obvious injuries that hadn't been tended-to (such as wrist cuts). I was told on more than one occasion that they must have done it between ER and the psych unit (even though security escorted them). It all made me want to scream!

whodunit · Jan 21, 2009

I also work as a ER/psych liaison and agree the ER is swamped .Our hospital is set up with rms which have windows and security sits outside crisis intervention so no other harm can befall them but as for the care they need when first coming to ER, I really feel they are shuffled to thru to the back burner.Case in point is nsg home pts or elderly pts who are acting out etc when its the result of a UTI that the docs don't even order checked. its like oh they will take care of that upstairs.Sometimes I get upset cause when I get to ER , there isn't even a chart half put together for me to see whats going on, the nurse taking care of the pt and the dr both are tied up who knows where and the choice is either to go in blind and find out whats happening with them or wait {who knows how long}to talk to staff only to find out nothing has been done period except to put them in a CI rm.ARRG!!!

Whispera, MSN, RN · Jan 21, 2009

This is somewhat related. When I worked on the psych floor in a general hospital, we had a terrible time getting the medical doctors to come to our floor to see our patients. I think once we got them, they were considered to be psych-only. One time a lady was very SOB, frightened, her breathing was breathing very labored and she was ashen. Her breath sounds were extremely poor. We could not get a doctor to come see her the evening I worked until the supervisor pushed a resident to come. The lady ended up being transferred to ICU and died. Turns out she had advanced lung cancer.

After that incident and a few others, we had a patient was seizing. The residents said they would be there ASAP but didn't think our need was a priority. After what seemed like forever, still no doctor! We ended up calling a code even though that was not what was needed. All we needed was a doctor, and we figured that would get one to come to our floor. It worked. That patient was transferred to ICU too, but did survive.

inthesky · Jan 21, 2009

Some of our hospitalists openly refuse to come (if we manage to even get a return phone call) and are often rude to the nurses. We had to contact the house supervisor on a rather regular basis. One doctor finally crossed the line with some serious verbal abuse to one of our nurses (was not the first time, but was the worst incident) and our psych doc and unit manager got involved. The doctor had to step down as lead attending hospitalist.

Things are better now as 3 docs volunteered to be the only docs who come here. We usually see only one doc, but we are satisfied as he is a great doctor and person in general.