Monitoring of psych patients

  1. My facility is pretty lax in monitoring of psych patients on night shift, regardless of whether they are on assault precautions, suicide precautions, escape precautions, or fall precautions. Patients are free to roam the facility during night shift when there are very few staff, which IMO places both staff and patients at risk. I'm wondering how other facilities monitor their patients.
    Last edit by medsurgrnco on Jul 8, '08 : Reason: spelling
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    About medsurgrnco

    Joined: Jan '08; Posts: 580; Likes: 365
    Specialty: Med-Surg, Psych


  3. by   rn/writer
    What you are describing is a disaster waiting to happen. If patients are on various types of precautions without the security/staff/protocols to back them up, your facility is a prime target for a tragic event. And the line staff will go down first. Higher ups and admin will likely have to field their share of recriminations, but you can be they will have layers of defense shielding them from losing their shirts.

    Seriously, I can't believe your risk management folks are okay with this. Maybe they don't know the full extent of the problems, and someone needs to make them aware.

    From an insurance standpoint, if these patients are deemed serious enough to require inpatient treatment and have further been placed on various kinds of safety checks, the facility is extremely derelict in it's duty if they are allowed to wander unsupervised. After all, one of the main justifications for inpatient psych treatment is that the patient is a danger to himself or others. If patients are well enough to come and go unsupervised, they should probably be in outpatient treatment.

    I would seriously consider working a more controlled shift or looking elsewhere for employment. I hate to be a gloom-and-doomer but based on my knowledge of and experience with psych, it's only a matter of time until someone gets hurt.
  4. by   aloevera
    I work days, but from what I hear at report and others tell me, it seems pretty much the same...If a pt. is on LOS or ADS or Fall prec. we have them on one small hall (6 pts. max ) with a tech to watch them....all other pts. are free to roam on the main part of the unit....their rooms being on the other 2 main halls....usually have anywhere from 25-30 pts.
    So we are monitering our suicidal, homocidal, fall prec. more closely than the other pts. If we have a 1-1 then we have one staff member with that pt. at all times....hope this helps....
  5. by   medsurgrnco
    Aloevera, your patients are monitored more closely than ours. Maybe you didn't realize I meant that even fall precaution, suicide precaution, assault precaution and escape precaution patients are roaming unsupervised throughout the facility. When I walk alone down to the kitchen to get my lunch or snacks, I don't know who I might see unsupervised.
  6. by   medsurgrnco
    Yes, I know this is a disaster waiting to happen. Part of the problem is insufficient staff with our hospital setup while another problem is the MHW who are lax in their supervision of patients.
  7. by   aloevera
    Yes, you are definately in a dangerous situation....Our high risk pts. (suicidal, homocidal, fall and elopment risk) are always on the small hall separated by glass from the nurses station. We have at least one tech with them at all times. We can also watch them, too. Even their meals are given to them on their hall. They only leave their area to see the Doc not far from their hall.
    They mingle with the other pts. ??????? That is definately a disaster waiting to happen....

  8. by   inthesky
    At my facility, all patients are on q15 minute watch. I do worry about not watching certain pts (fall, suicide, homicide, etc) more closely. At night, patients have to stay in their rooms.
  9. by   floxy124
    Hi your are really at risk going by the kind of set up you guys are operating out there.In my facility patients stay in theirrooms at nights .Though close observations are maintained for patients with suicidal ideations high risk for violence risk for fall and other cases that require q15mts attentions. I hope this answers your questions.
  10. by   Thunderwolf
    Quote from medsurgrnco
    Yes, I know this is a disaster waiting to happen. Part of the problem is insufficient staff with our hospital setup while another problem is the MHW who are lax in their supervision of patients.

    Safety is only as good as the milieu.
    It wouldn't take much to upset the apple cart at your facility.
    It is just a matter of time before the comfort of naivety/denial gives way to the harsh realities.
    Currently, it sounds like your facility is just short of being the best kept secret of a Personality Disorder paradise.

    You have big hugs coming to need them.
    Last edit by Thunderwolf on Jul 13, '08
  11. by   medsurgrnco
    A borderline pt tried to commit suicide on my shift. Not only was the pt not monitored per expectations (LOS), the pt was able to obtain 3 items with which to attempt suicide, and the MHW doing the safety check of the facility didn't find items hidden in the pt room. Hello, was I the only employee working there that realized we worked in a psych facility?! I'm no longer working there.