Rights of Psych Patients?

aura_of_laura · Feb 25, 2010

They can refuse a urine screen. You just document "refused." To restrain a patient for a urine sample would be a ridiculous (and unjustifiable) use of force. While a UDS can be helpful, it isn't necessary for medical clearance. My facility admits patients from other EDs, and many times the patient has refused - we keep trying, but sometimes they're even discharged without a UDS.

If they're an OD patient, a urinalysis is beside the point - they're going to need serial labs from blood draws.

sewingkelli · Feb 25, 2010

nope not an OD patient, just a stubborn young female with obvious psyc issues.

BUT, because they aren't in the "right state of mind" do they have the right to refuse?

aura_of_laura · Feb 25, 2010

Absolutely she can refuse. A UDS is in no way necessary for her safety or the safety of others. She can also refuse any medication she likes unless her behaviour warrants a physical or chemical restraint - and the only time either of those are justified is if she is an immediate physical threat to herself or others.

sewingkelli · Feb 25, 2010

just for the record I agree with you, but this is an issue that is bothering me and think I may take it to my superiors.

aura_of_laura · Feb 25, 2010

I'm sure your hospital's ethics board would be able to help you out - most facilities have a "mental health patient's Bill of Rights," or something like one. Without knowing too many details, it sounds like everyone could use a refresher on those rights..! Don't let an immediate supervisor blow off your concerns, either...

sewingkelli · Feb 25, 2010

Thanks I am definitely going to look into it.

Meriwhen, ASN, BSN, MSN, RN · Feb 25, 2010

For the most part, Psych patients have the same rights as any other patient. They can refuse treatment and medications (unless they are court ordered), and unless they are being temporarily detained under legal order, they can check themselves out any time.

sewingkelli · Feb 25, 2010

what if they admit to SI/HI, then they can't sign out right?

Meriwhen, ASN, BSN, MSN, RN · Feb 25, 2010

what if they admit to SI/HI, then they can't sign out right?

Their verbalizing SI/HI is not automatic grounds for keeping them. To keep them, you would have to get a temporary detaining order--you'd have to prove to the magistrate that this person is an immediate danger to themselves and/or others. If you do obtain a TDO for the patient, then the patient can be held involuntarily for 48-72 hours (depending on your jurisdiction), after which they must go to court to have thier case reviewed.

If you can't obtain the TDO, then you can't hold them...but depending on your local laws, you may still be obligated to contact the person(s) the patient is verbalizing HI against to notify them.

sewingkelli · Feb 25, 2010

here is where I am coming from, I am an ED nurse and this is all before psyc workers see them. They need to be medically cleared first and then psyc will see them, if the ED doctor feels they need to be seen, now I work overnights and psyc leaves at 10pm or so. If we get someone after that they stay overnight in the ED and see psyc in the morning and cannot sign out.

My biggest concern is a patient that we, not I, had in the deptartment who was clearly a psyc case, needed psyc intervention, she refused to give a urine. Do they have that right to refuse or do we get the urine "by any means".

I have to do more research when I get to work to look at the intranet there.

aura_of_laura · Feb 25, 2010

Psych legalities are pretty complicated, and it's great to familiarize yourself with them. Does your ER have a psych nurse liaison that you could talk to? Every state is a little bit different, and there are a lot of subtleties to commitment types (201, 302, and Act 147 are the ones I deal with most often).