"Take Downs"

talaxandra · Sep 23, 2005

We have code greys for any incident of aggression "that cannot be handled locally, safely and effectively".

They can be called by any memeber of staff. Switch announces "code grey" and the location over the PA, alerting staff on the ward, the nursing superviser, the medical unit and security; four members of security arrive, usually within a couple of minutes. Instituting the code grey system was brilliant - for a start, I hadn't had any idea until then how often patients (and family members) became aggressive, or how systemic a problem it was.

It's been fantastic for the staff - just knowing that those resources are available gives us a little breathing room - I, for one, don't feel so alone, which takes off some of the pressure and urgency I used to feel when dealing with aggressive people.

Having explicit permission to call security also allows us to warn the aggressive patient that if they don't calm down we will call for back up. At least half the time this alone is enough.

r_janice · Sep 23, 2005

What about on psych units? What is the training like to do that kind of thing?

At the psych facility I work in as far as training, all staff are mandated to participate in NCI, which is non-violent crisis intervention. During this inservice, the instructor goes over ways to handle situations without hurting yourself or the pt. For example, they show how to get out of a choke hole or if the pt grabs your wrist how to get them to let go.

Agressive pts. family and etc......The staff dials a # that tells security to announce "Dr. Strong- (with the Unit)" over the PA when extra man power is needed due to an incident. This alerts staff on other units that they need to get to the particular unit that is having issues. :)

We've been hearing alot of those announcements lately too :crying2:

Meerkat · Sep 23, 2005

At the psych facility I work in as far as training, all staff are mandated to participate in NCI, which is non-violent crisis intervention. During this inservice, the instructor goes over ways to handle situations without hurting yourself or the pt. For example, they show how to get out of a choke hole or if the pt grabs your wrist how to get them to let go.
Agressive pts. family and etc......The staff dials a # that tells security to announce "Dr. Strong- (with the Unit)" over the PA when extra man power is needed due to an incident. This alerts staff on other units that they need to get to the particular unit that is having issues. :)
We've been hearing alot of those announcements lately too

Wow! Thanks for the info!

I am [hopefully] about to start work in a psych unit, and I'm really excited but a little scared----in the interview they told me that some of the pts are VERY violent. Can you recommend any good sites or reading on the subject?

elkpark · Sep 23, 2005

Wow! Thanks for the info!
I am [hopefully] about to start work in a psych unit, and I'm really excited but a little scared----in the interview they told me that some of the pts are VERY violent. Can you recommend any good sites or reading on the subject?

The psych unit will provide you with training in whatever techniques they want you to use for dealing with violent clients (and, typically, require annual "refresher" training), and it is important that you take the training seriously and use only the approved techniques when dealing with clients. These programs are designed to protect both you and the client from injury, and, remember, it's always better to defuse a situation before it gets physical (if that is possible -- sometimes it is, sometimes it isn't) than to end up wrestling someone down to the floor. Most of these type of intervention programs stress techniques for defusing/de-escalating situations at least as much as they stress physical interventions.

If you use any other kind of "self-defense" techniques (or just pure instinct ...) that could result in injury to the client, you can end up being fired and/or being charged with assault. The staff are responsible for the client's safety -- you don't have the option of just reacting the way you would if, say, you were being attacked on the street.

BKRN · Sep 23, 2005

At the hospital I work in we call a "Dr Quick" for aggressive pts or family, a "Dr Quick STAT" if a weapon is involved. Our security, nursing supervisor and any hands available is usually there in a matter of seconds. Other than knowing who to call if there is a situation and having common since-we are not provided any other training to deal with these matters.

SmilingBluEyes · Sep 23, 2005

It's a code white where I work, and all available/nearby personnel respond.

Havin' A Party!, ASN, RN · Sep 23, 2005

... staff are mandated to participate in NCI, which is non-violent crisis intervention...

Ditto at our facility.

We use a "Code Green."

r_janice · Sep 23, 2005

The psych unit will provide you with training in whatever techniques they want you to use for dealing with violent clients (and, typically, require annual "refresher" training), and it is important that you take the training seriously and use only the approved techniques when dealing with clients. Most of these type of intervention programs stress techniques for defusing/de-escalating situations at least as much as they stress physical interventions.

:yeahthat: I second that!!

r_janice · Sep 23, 2005

Ditto at our facility.
We use a "Code Green."

We use Code Green for elopements!!

FeelGDRN · Sep 23, 2005

I worked in inpatient psychiatric units. I received a course called CBI Crisis behavioral Intervention I think. It teaches how to safely intervene when a patient becomes physically combative. The course is usually patient focused to prevent injuries to them. In reality, your survival instinct takes over. Defusing a situation is much easier when you approach patient who is fidgeting or displaying othe anxiety symptoms and speak to them. You can easily speak to their strengths and ability to think through whats going on. Another good warning sign is when people are talking and you notice an increase in volume. Even if its only a slight increase, chances are the patients are experiencing some underlying agitation. Redirection is your best tool. Redirect patient together getting agitated to another activity, generally in seperate areas. Redirect anxious patients to an activity that they enjoy or one that requires some level of focus. My experience is that when these crisis events take place, a show of force can be extremely effective. If its not then the charge nurse will assign limbs to take(security and staff). He or she will take a direct approach to deflate the situation and give the patient a choice of avenues. If the patient has lost control of his/her ability to chose then we would intervene. Getting the patient down as safely as possible and then administering medication(IM) to help him/her gain better control. Its always an adrenaline pumping event. But it does become easier when you are familier with what happens. It becomes part of your job that you hate. But you know basically what to expect. Good luck. The majority of your time 95% will be working with disturbed patients who need an objective, clinical ear. You can "Walk with them on their journey for a few days" Thats something I said in nursing school. But it still has meaning.

MadRedneckRN · Sep 24, 2005

I work at an in patient psych hospital. All of my patients have crimminal charges pending. We do physical "take down" training every 6 months. At my facillity, I have a "panic" button on my keychain. If I feel I need help with a patient, I push the button and a "code 10" is announced over the PA. The computer can pinpoint the exact location of the button within 10 feet so people know exactly where they are needed. I usually have 6-8 people there in about 20 seconds. It's nice. I've only pushed it once in 6 months. A couple of patients got into a fist fight and started using pool balls as weapons!! Fun evening!!