Safety Policies

Bjo · Dec 3, 2004

I was the clinical nurse manager for an adolescent psych unit a couple of years ago. We had policies on visitation and safety searches, confidentiality (now HIPPA) seclusion and restraint (as a last resort when all lesser interventions have failed)

If you review the old policies you should be able to get through them fairly quickly. They may just need some updates to comply with regulatory agencies.

Good luck

Hukilau · Dec 3, 2004

Hello All
I am currently reviewing the safety policies for the adolescent inpatient psych unit I work on. Any input any of you have on areas I should develop policies for OR if any of you have sample policies from your facility you could fax me, please email me.
Thank you so much...any help is appreciated.
Jenn
So far I am looking at:
1) levels of observation
2) AWOL's
3) suicide precautions
4) pt and belonging searches
5) off ward priviledges

- Contraband (a list of items not allowed on unit or only allowed under direct supervision. Most adolescent units prohibit "gang associated" clothing, for example)

- Personal contact. (Girls and boys together on unit? What kind of touching is OK?)

- Phone and visiting (Be sure you know the laws for your state. I worked in Protection and Advocacy in one state and MANY adolescent units had restrictions which were prohibited by law)

After you get the basics down, then any time something happens that you need to make a decision about, :confused: immediately write a policy to cover it next time:wink2:

Bjo · Dec 5, 2004

maybe look at on unit privileges as well. like what level can pick the television or movie programs, or the radio station. we also had policies on assault precautions. i agree with hukilau:get that policy written to cya.

Meraki · Dec 9, 2004

Thanks Bjo and Hukilau

Basically the reason I am taking on this project is that we have no written policies on the floor...scary...and there was recently a death and inquest at another facility near us that sparked my boss to find the $ to pay someone to do this! CYA is the real reason for sure!

I'm doing lit reviews etc...and slowly working out a draft....of course wording it in such a way that everyone is happy is another nightmare!!

Any more input would be great

Jenn

Bjo · Dec 9, 2004

Just make sure that your policies follow the regulatory agencies that oversee your facility.

We had trouble satisfying JCAHO and Medicaid at the same time. What one wanted the other didn't think was necessary and vice versa.

It sounds like you have your work cut out for you. They have good info on www.hospitalsoup.com

Just log into the nurse manager area where they have lots of policies already written and you just have to change the wording a little.

skyblue · Mar 25, 2005

I am an RN working in an acute-care psychiatric hospital. We just started implementing safety searches Q shift which includes lifting the bed, searching

through the patients' belongings, lifting the lid of water tank in the washroom, and checking garbage bins for contrabands. Aside from these, nurses are expected to ask the patients to empty their pockets after utilizing their offward privilege and show us whatever they are bringing in. Visitors are also required to show us whatever they

are bringing in. While we are aware about the importance of ensuring safety in a psych, unit., the nurses are frustrated as we do not have enough time to do all these searches and at the same time assessing, and attending to the needs of the patients. Because of these q shift safety checks, patients are complaining about not having enough privacy as well as nurses not available to attend to their needs as much as they want to. We do close obs. with our acute patients as well as environmental checks Q hr., thorough body and belongings search for contrabands during admission. Lighters and cigarettes are kept in each patient's cubby hole and used razors are returned and disposed by nurses.

Our nurse manager assured us that we are not forensic, but that we need to do this

for our own safety in our practice and that should there be an inquest, there is a

proof that we did our safety search q shift - we ticked off and signed our initials.

My point is there has to be a balance in ensuring the safety of our patients and at the

same time giving them the privacy that they need .

Does anyone have any suggestions about safety searches?

skyblue · Mar 25, 2005

I am an RN working in an acute-care psychiatric hospital. We just started implementing safety searches Q shift which includes lifting the bed, searching

through the patients' belongings, lifting the lid of water tank in the washroom, and checking garbage bins for contrabands. Aside from these, nurses are expected to ask the patients to empty their pockets after utilizing their offward privilege and show us whatever they are bringing in. Visitors are also required to show us whatever they

are bringing in. While we are aware about the importance of ensuring safety in a psych unit, the nurses are frustrated as we do not have enough time to do all these searches and at the same time assessing, and attending to the needs of the patients. Because of these q shift safety checks, patients are complaining about not having enough privacy as well as nurses not available to attend to their needs as much as they want to. We do close obs. with our acute patients as well as environmental checks Q hr., thorough body and belongings search for contrabands during admission. Lighters and cigarettes are kept in each patient's cubby hole and used razors are returned and disposed by nurses.

Our nurse manager assured us that we are not forensic, but that we need to do this

for our own safety in our practice and that should there be an inquest, there is a

proof that we did our safety search q shift - we ticked off and signed our initials.

My point is there has to be a balance in ensuring the safety of our patients and at the

same time giving them the privacy that they need .

Does anyone have any suggestions about safety searches?

Hukilau · Mar 25, 2005

I am an RN working in an acute-care psychiatric hospital. We just started implementing safety searches Q shift which includes lifting the bed, searching
through the patients' belongings, lifting the lid of water tank in the washroom, and checking garbage bins for contrabands. Aside from these, nurses are expected to ask the patients to empty their pockets after utilizing their offward privilege and show us whatever they are bringing in. Visitors are also required to show us whatever they
are bringing in. While we are aware about the importance of ensuring safety in a psych unit, the nurses are frustrated as we do not have enough time to do all these searches and at the same time assessing, and attending to the needs of the patients. Because of these q shift safety checks, patients are complaining about not having enough privacy as well as nurses not available to attend to their needs as much as they want to. We do close obs. with our acute patients as well as environmental checks Q hr., thorough body and belongings search for contrabands during admission. Lighters and cigarettes are kept in each patient's cubby hole and used razors are returned and disposed by nurses.
Our nurse manager assured us that we are not forensic, but that we need to do this
for our own safety in our practice and that should there be an inquest, there is a
proof that we did our safety search q shift - we ticked off and signed our initials.
My point is there has to be a balance in ensuring the safety of our patients and at the
same time giving them the privacy that they need .
Does anyone have any suggestions about safety searches?

I have worked in at least a couple of dozen different psych units all over the country during the past 30 years. Every place has a different policy regarding safety checks and searches.

i can assure you that you are on the extreme end of the spectrum. Q shift checks are way beyond the norm. Having patients turn out their pockets after being off the unit is way beyond the norm. You are correct that there needs to be a balance between safety, privacy, and what is reasonably possible with the resources you have.

I would suggest that you research psych facilities in your area, or similar facilities anywhere, and find out what the norm is.

Don't expect your nurse manager to be swayed by the evidence, however.

One thing I have learned is that, with a few notable exceptions, once a manager believes that things MUST be done a certain way, no amount of evidence to the contrary will change their mind. Actually, this also applies to staff who have only worked at one facility.

Here is a reasonable plan based on the best I have seen... usually worked out by experienced staff during many years of practice:

1)Take all pt. belongings BEFORE they come on the unit. Have the belongings searched by staff and separated into four piles: Stuff they can have back immediately, stuff that needs to be locked up and used under supervision, stuff that will be locked up and returned upon discharge, and illegal stuff that will either be destroyed or turned over to authorities.

If your pts all come through ER or from other hospitals, it's best if they're changed into hospital gowns before they come on the unit so their clothes can be searched.

2)Do check everything brought in by family/friends. Allow visiting only in community areas that are monitored by staff.

3)Do check pts on return from pass. (Few places actually allow passes any more.)

4)Have Day and Eve charge nurse do room to room rounds at change of shift, but this just needs to be a quick look at each room.

5)If there is reason to believe that there is dangerous contraband on the unit, call a community meeting and have two staff search room by room, with the pt present if they so desire. This should happen rarely.

6) Finally, teach all staff to be constantly observant. When you need to go in a pts room, look around. If you see something that shouldn't be there, calmly let the pt know that you need to take it.

Most of the time, pts will act as they perceive you expect them to. If the environment is one of suspicion and total control by staff, then pts will not feel obligated to show any responsibility for themselves or the community.

Enough. I hope this might help generate some thought and discussion at least. I have helped start two different units from Day I and also helped two units in the transition from open, totally voluntary to closed invol., so I've thought about and worked on these issues a lot!

Bjo · Mar 25, 2005

Just a couple of suggestions. We have the tank lids on the commodes bolted down so we don't have to check inside of them. Secondly, we don't search visitors but they aren't allowed to bring purses or packages on the unit. We have a visitors locker that they have to use for these things. They hold the key until visitation is over and then remove their belongings to take home with them. Any packages brought in for patients during the visitation must be checked before the patient receives them.

We have off ward privileges as well. We don't do a full search but we do use a hand held scanner to check for anything that would be metal.

We still do ward searches as well. Just a quick look over at the start and end of every shift. We don't do the complete top to bottom search unless we suspect contraband.

If this is something new you have just started, the patients should adjust to it as long as you are consistent and explain to them that it is to ensure everyone's safety. If they are strongly opposed to it, perhaps these patients need a more thorough search!

Hukilau · Mar 25, 2005

Just a couple of suggestions. We have the tank lids on the commodes bolted down so we don't have to check inside of them. Secondly, we don't search visitors but they aren't allowed to bring purses or packages on the unit. We have a visitors locker that they have to use for these things. They hold the key until visitation is over and then remove their belongings to take home with them. Any packages brought in for patients during the visitation must be checked before the patient receives them.
We have off ward privileges as well. We don't do a full search but we do use a hand held scanner to check for anything that would be metal.
We still do ward searches as well. Just a quick look over at the start and end of every shift. We don't do the complete top to bottom search unless we suspect contraband.
If this is something new you have just started, the patients should adjust to it as long as you are consistent and explain to them that it is to ensure everyone's safety. If they are strongly opposed to it, perhaps these patients need a more thorough search!

Most of your reply makes good sense, but I am a little disturbed by your last sentence. It's possible that some pts might be strongly opposed to having their room tossed because they are trying to hold onto some sense of dignity during a difficult time in their lives. To suggest that you should perhaps be MORE suspicious because someone objects to such an over-the-top invasion of privacy suggests a lack of understanding of basic human dynamics.

Bjo · Mar 25, 2005

Most of your reply makes good sense, but I am a little disturbed by your last sentence. It's possible that some pts might be strongly opposed to having their room tossed because they are trying to hold onto some sense of dignity during a difficult time in their lives. To suggest that you should perhaps be MORE suspicious because someone objects to such an over-the-top invasion of privacy suggests a lack of understanding of basic human dynamics.

I stand corrected. I didn't mean that ALL who strongly oppose should be suspect. I should have said that SOME may be more likely to have contraband. You're right that many will have other issues relating to the invasion of privacy. I should have been more clear.

I also wanted to add that the approach the staff take during the searches can have an impact on how the patients accept it also.