Search and Seizure

[Meraki]

Just wondering what happens on your units....

If you are highly suspicious or have confirmation that a patient has illicit drugs, razor blades, a knife, a lighter or other serious contraband on your unit and they refuse to hand it over and they refuse to consent to a person or property search....what are your next steps??

If they are voluntary, are they seen by psychiatrist and given the option of discharge vs being searched??

Do you call in security or police and search them involuntarily or you just restrain them and remove then item yourself?

Or do you leave them ,put them under closer obs, restrict movements, etc....

Also what if on admission, a pt refuses to empty pockets or be searched?

Any ideas??...I work on an inpatient adolescent crisis unit in Canada

Thanks

[medpsychRN]

Voluntary or not, people on our unit don't have a choice. If they are coming from the ER, they are already gowned which helps. Most people cooperate. Those who are unwilling are usually hiding something. We try to persuade/reason with them. There's only been one time we actually held someone down and searched them. They had a ton of drugs hidden in their underwear!

[TitaniaSidhe]

They arrive to our unit with the police present. (Adullt locked admissions- VA so federal) They are searched regardless if they consent or not. Generally no they are not given the option of signing out once they have arrived to the unit. Of course we try to make it as respectful as possible for the patient however, safety has to come first. If they have weapons, drugs or pharaphenelia they will be issued a federal summons by the police & it carries $500 or more fine plus possible jail time depending on the judge at the court date.

[032249m]

I work in a state psychiatric facility. All of our patients are searched and scanned as they enter the facility. They are searched again when they arrive on the ward. If we suspect contraband after a patient is admitted, we require a physician's order to search. Patient and a member of the same sex as patient must be present during the search. Despite our best efforts, patients seem to be able to obtain and/or keep contraband.

[CharlieRN]

Our patients are told they will be searched in admissions. Hopefully we talk them into it. If they balk on the unit we would call the doctor on call for orders to either discharge immediately, place on one to one, constant observation or to do a forced strip and search. The latter would require that the MD be present or sign his telephone order within one hour. We would use the police as a backup if the patient were so violent as to be beyond our ablity to control. Use of police is discouraged since once we call them in, they are in charge.

The only cases of refusing search I recall have been child patients. The most recent was a five year old, admitted in the middle of the night, who was spectacularly uncooperative. He was willing to go to sleep in his clothes and the charge nurse opted to do his search as part of giving him a bath in the morning.

[032249m]

Speaking of one to one's. Do you have that many? Our hospital is having a real problem with staffing for the one to one's. In a force search, we have just developed a "mediation team". These are the best of our employees who have demonstrated ability to defuse and re-direct patients. They would be called as a kind of "show of force". Rarely are our police called in.

[CharlieRN]

We tried a "crisis team" approach a few years back with good results. We hired several really big, strong and extreamly well trained guys. Not just well trained in techniques of physical control but also very expert in techniques of verbal and non verbal, hands off, crisis management. I used to call them the "goon sguad" because they were in fact just the opposit of goons. They would take over in a crisis, and if necessary lead the show of support. More often than not they defused the crisis without the need for hands on. Unfortunately people trained at that level don't come cheap, and you can't use them as regular staff if they are going to be free to respond to emergencies. One benifit was that they trained the rest of the staff up to a even higher level of competence.

[ARNPsomeday]

Interesting question, jecado. Thanks for posting it.

CharlieRN, where do you find such a great group of guys? (I'm still in school but learn all I can about psych which is where I wish to be.) Are they EMTs with special training? Were they trained at the psych hospital itself? In my city, that's where the police get their CIT training. Don't know if this is the usual.

[CharlieRN]

I was not part of the hiring process but the mix was eglectic(sp). They had a veriety of backgrounds, and differing levels of education. I don't believe any were less than bachelor level and some were master's level. Some may have had law enforcement backgrounds. All of them are in supervisory possitions now.

Not all who seemed to have the "right stuff" worked out in practice. One of them I knew had been my patient when i worked at another facility, and had a dx of DID, of course I could say nothing to my employers about her background. I did know that she was a good person and extreamly intelligent. In any case I watched her come apart at the seams over the next few weeks.