"blacklist" for patients?

[beccajean]

The hospital that I work in has the most secure beds (I am told) in the state. Thus, we get really, really sick people. In the almost 5 years I have worked there, there have been 2 instances where a patient has violently assaulted staff (that was not related to psychosis), been discharged (a few weeks later in one case, the same day in the other !) and then been readmitted within 2-3 days. Staff is always outraged, feeling that administration and the docs don't support them. :mad: When I've asked my nurse managers about why the patient couldn't have been refused admission, I am told that "a long time ago" there used to be a blacklist, but the legal department advised the hospital that there couldn't be one. In the most recent case, the patient was not allowed to leave the secure day room, was not allowed to interact with other patients, and was not allowed to attend groups. The patient got 1:1 time with the activity therapist (with male staff stand by, of course). It doesn't seem like, therapeutically, it's in the best interest of a patient to be readmitted when there has been staff injury because of their sociopathic behavior. I am just feeling really frustrated by this, and would love to hear if your hospital has a policy about violent offenders with recent behaviors.

[caliotter3]

A family member was told that the police would be called if he made good on his threat to come back with a firearm after his loved one passed and he started making accusations against the staff. That is the closest to banning someone from the premises that I have seen.

[mentalhealthRN]

Where I worked we had a list but it was more of a "do not admit without serious consideration" list. Mostly on it were those with pretty bad Borderline PD who they found got no benefit out of being admitted. I saw one or two maybe ever admitted. They needed to be approved by not only the doc who saw the pt and did the eval but by the director of the Psych ER as well. Others on the list were pts known for a serious Malingering hx. As far as pts with a serious violent past sometimes they would see about another hospital taking the pt. but usually if they were that bad the other hospitals didn't want them either as they were well known. I did have a few docs though that were good as far as if the dx was clearly sociopathic PD they believed that there was no meds or tx that an admit could help and wouldn't admit. They would say those people generally belong in jail/prison and its just a matter of time until they do something to land them there. If there were actual threats they would call and let the police know they were releasing someone and that a specific threat had been made and give them the name of that person so they could follow up and provide protection and inform this individual of the threat against them. So as far as your situation you could look into pressing charges against the person. You may or may not get anywhere depending on if there are other MH dx that could get them out of it but if only SPD you may have a case. I would talk to the docs and find out what you can do to protect yourselves. The other option is to discuss the need for 24/7 security on the unit when these individuals return. We were successful in getting the manager and security to agree to this on one case and it helped a lot. We had no further incident with the guy. They sat outside his door the entire time he was there and he had no incidents with staff injuries. That is something you could try to get. Good luck to you.

[Popwhizbangz, LPN]

Its uncommon in general, I'm told, but where I work we have a PNG (Persona Non Grata - Latin for "not welcome back" basically).

Doctor files it with Admissions Dep., describes reasoning for it, and it usually sticks, with a variable duration set by the doc filing it, sometimes permanent. Legal department is fine with it, its been used for years.

The problems are mostly political - another hospital or ER gets mad we won't take a problem off their hands, pressure is applied, and our admin pushes to override the PNG as a result.

We too have had some very dangerous patients returned to us against our will, with pretty bad results. Happily rare - sometimes no amount of liability or upset from outside could be worse that the results of caving.

[beccajean]

Thank you all for your replies. Popwhizbangz, I like the idea of the PNG. I'm going to do a bit more investigating at work. Talk to the docs, etc, see what can be done.

[NPvampire, MSN, RN, APRN]

Hmm...yes, I've seen a few patients become PNG. For permanent PNG, usually the doctor has to be seriously PO'd or assaulted. We mere nurses aren't enough. Sometimes the hospitals will "alternate" taking them into acute inpatient, one month hospital A, next month hospital B, next time back to A.

[Popwhizbangz, LPN]

Of course, there are no guarantees......

[nina539]

Hmm...yes, I've seen a few patients become PNG. For permanent PNG, usually the doctor has to be seriously PO'd or assaulted. We mere nurses aren't enough. Sometimes the hospitals will "alternate" taking them into acute inpatient, one month hospital A, next month hospital B, next time back to A.

That makes me really sad to hear. In the last year we had a psych nurse, a psych tech and a med-surge nurse (responding to a mistakenly called code) all assaulted by the same violent pt. 2 concussions and a broken nose were obviously cause for concern. Until we could get this pt moved to a more secure long term facility we kept him secluded from other pts with additional staff/security. Our doctors fully supported the nursing staff through this and this person will never again be allowed for admission. You have my sympathy, it must be terrible to not have the support of the doctors you work with.

To get back on topic, we do have a list of PNG which my facility keeps. All the doctor has to do is give the word and they are added to an unofficial list. The problem is when the pt presents at our ER or another. Then its up to the doc to explain why we are not admitting them. The usual reasons are because these are pts we have seen time and time again who do not benefit from our acute setting. Our unit has not been "therapeutic". Although ultimately if someone meets criteria it is really difficult to deny them treatment.

[Yosemite, RN, ASN, EMT-I]

In one hospital I worked in, there was a very "unofficial" and secret list. The ONLY people who were on that list were the ones that cost the facility more money than they made off of them... even if it was just in liability. Those VERY few were called "treatment failures" and it was recommended they be submitted to other facilities.

[RN4life74]

We have been told that there is no such thing as a "do not admit" patient. We admit EVERY patient that comes in to the ED with a psych issue. Patients who have assaulted our staff- readmitted. Patients who have created chaos by pulling the fire alarm-readmitted. Patients who have been sexually inappropriate with females (including staff and adolescent female patients)-readmitted. I could go on and on. We are to keep the beds filled! Eight admissions in 1 shift? Sorry, gotta fill the beds.

[Yosemite, RN, ASN, EMT-I]

yes, rn4life74, that same facility i worked for had the same "policy" until the lawsuits (one i know from another client), workman's compensation claims, bills for facility repairs, and calls from local law enforcement concerning staff (trying to) pressing charges against clients that assault them start rolling in. when cost of service exceed profits, the "unofficial list" will be created (you just may never know about it).