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Pt trying to elope/injection

Psychiatric   (356 Views 2 Comments)
by lucy8686 lucy8686 (New Member) New Member Nurse

299 Profile Views; 6 Posts

If a psych patient is trying the doors, attempting to leave and isn’t responding to redirection and hospital police have to come and physically remove them from the area while they flail and and try to push past staff Tao get to the door, would you consider this “imminent risk” and consider an IM injection? 

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hppygr8ful has 15 years experience and specializes in Psych, Addictions, Elder Care, L&D.

5 Followers; 2,763 Posts; 32,250 Profile Views

There are a lot of variables involved with emergency interventions in the Psych environment these days. Use of Chemical and Physical restraint is frowned upon and should only be used when all other interventions have not worked.  Facilities and nurses in particular are being heavily scrutinized in these situations. In California you cannot give an emergency injection until you have given the patient the opportunity to take it by mouth and then you are required to allow time for the med to work before further intervention.

So I have some thoughts.

If this a psych hospital where is the behavioral staff who are trained to keep people away from the doors and how to redirect negative behavior. Often redirecting to another area offering a snack or yes oral meds can be quite effective if the situation has not been allowed to escalate to a crises.

If this is an acute medical setting such as an ER patient must have a 1:1 staff to keep them occupied/entertained until a transfer can be arranged. 

In the situation above in our setting we would have a staff with good repour approach the patient ask them what was going on right now  and how we can help. No demands to step away from the door or laying hands on the patient yet. In a case today with an very large autistic teenager who was hitting himself, banging his head on the door and growling at staff. Our intervention was to toss a stress ball to him which he caught with both hands. Once I had eye contact I was able to establish that he wanted to talk to him mom. Set him up on the phone and he was calm. No one got hurt, no need to medicate.

So no I would not find that the details described would absolutely require IM medication. 

We are currently doing therapeutic holds for up to an hour or more rather that resort to chemical or Restraints involving straps and locks.

 

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