Signing from involuntary to voluntary

Specialties Psychiatric

Published

Hello,

My employer is an inpatient psychiatric unit and most of our patients come in under involuntary status. The acuity on our unit is fairly low so the "culture" here is to have them sign to voluntary status almost as soon as they come in the door. The state, however, has been pressuring the facility to initiate treatment faster on our uninsured patients. We don't have a provider on site 24/7. So the facility came up with the idea of the RNs doing a nursing assessment (which we do anyway) and reporting the findings to the on call provider and get a telephone order to sign the patient to voluntary status. Is this something that sounds ok to you guys? Is this being done anywhere else? I'm my experience a patient has to be evaluated face to face by a provider to determine decision making capacity before they are allowed to sign voluntary. We (the RNs I work with and myself) have contacted the BON here in TN and they told us they cannot comment on the legality or if this is within our scope of practice or not. But the facility is forcing us to do this after hours when a provider is not there and we all know we will be held accountable if something backfires.

Thanks,

Cristy

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Specializes in mental health / psychiatic nursing.

Is this "involuntary status" an emergency hold or civil commitment (or other form of legal involuntary status)?

An emergency hold requires evaluation by a Licensed Independent Provider (MD, and NP in some states) and starts the legal process towards a commitment hearing. The LIP must see the patient within a period of time (varies state to state) to determine if the patient meets criteria for the hold, if the answer is yes, the legal process towards a commitment hearing starts. If no, then the hold may be dropped and the patient released to the community, or the patient may request to stay voluntarily for treatment.

If the person is involuntarily committed by the court then changing status requires LIP assessment and agreement of the court monitor to change to voluntary status. In either case, this doesn't seem like something that should/can be done with a verbal order based on RN assessment (though if an RN strongly believes that patient no longer needs involuntary treatment they can certainly advocate to provider and court for a change of status).

The above is my understanding based on my state laws - however as I'm not in Tennessee I'd recommend reading the applicable codes and statues for your state regarding Mental Health Law.

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They have the first CON written, so just a hold. I have tried for a while to find laws concerning this but to no avail.

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On 7/28/2019 at 7:17 PM, janikc said:

They have the first CON written, so just a hold. I have tried for a while to find laws concerning this but to no avail.

In Texas the answers to your questions are found in the TAC, which is the Texas Administration Code. All the info on the criteria to meet involuntary status, how long a warrant or a Emergency Peace Officer Warrant aka: EPOW are good for and who is aloud to discontinue each.

I worked at an emergency crisis Ctr without a MD on premises and we used Telemed. This worked exceptionally well and there was always a Dr available which as extremely important when emergency meds were needed as soon as some psych patients hit the door! No one was admitted without seeing 1st an RN to perform assessment & determine if patient was Medically stable enough to stay. 2nd. A therapist, & 3rd a doctor on Telemed.

See if there’s something similar to the TAC available in your state. Possibly through the Attorney General website.

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