SI patient

[Guest1139443, BSN]

Hi, all. So I recently had an incident and wanted some opinions. We had a patient brought in by EMS to the ER for SI for possible OD the previous say on fentanyl and patient stated he did take more right before he was brought in. So we let the patient know that we have to change him out into paper scrubs, let him keep his own underwear I check him over make sure I took anything he could hurt himself with, and patient told me he didn't have any drugs on him. Anyways, a little later the sitter I have on the patient takes him to the bathroom and then does not supervise patient while in restroom, and patient was in bathroom for sometime. She brings the patient back to the room, and a piece of rolled up cardboard comes out of the hospital issued socks, and we note the patient has become more sleepy. We narcan the patient and Dr and myself ask patient if he took anything in the bathroom. Patient says no so we have security check the patient over again and they found a small pouch of drugs in the band of his underwear.

I'm really upset I feel like I missed something, and don't want to get in trouble for this, I checked the patient and found nothing on him initially. I also don't want to get in trouble for this.

[amoLucia]

Be aware - substance abusers are freq MASTERS OF DECEPTION and know tricks that you have NO idea exist. Also, pts, having made the suicide decision, are intensely determined and it will be diff to alter the choice made. Put the 2 personalities together and there's a disaster ready to happen and hard to prevent.

Perhaps you REALLY didn't pay enough attn to his underwear. But he may have ANTICIPATED that you might just do a cursory exam, if even, so that's where he hid his cache. BTW, what about his footwear?

You'll learn from this for the future.

[emtb2rn, BSN, RN, EMT-B]

Well, you’re not gonna do a cavity search. Shoes & socks come off, 1:1 eyes on pt even in restroom. Never trust a junkie, that monkey has teeth & claws. And just enough narcan to keep ‘em sleeping & breathing as narcan does not improve personality in higher doses.

You won’t get in trouble.

[STEMIRN, BSN, RN]

Are you trained how to search pts, as a inpt psych nurse/tech? I've had a pt wrap a razor blade in Kleenex and hide it under his scrotum! I had no idea, and didn't even think to look under his scrotum! My mgr was going to write me up, and I had some very good CCL (Clinical Care Leaders) who stuck up for me, and reminded my mgr that we were never trained how to properly search a psych pt. I would also look for your hospital policy to help CYA!

[canoehead, BSN, RN]

If a patient knows they are going to the ER and wants to hide something, you won't find it. I think we need to put more emphasis on building relationships and openness with our patients instead of breaking down trust with invasive searches.

Yes, asking them to surrender weapons, pills, etc is reasonable. But checking under scrotums seems less than useful.

[Guest219794]

If somebody has something they don't want found, they generally put is someplace nobody is going to look.

Follow the policies of the institution. We aren't superheroes prepared to battle death, we are nurses.