The hospital where I work has started a new policy to keep all doors on the floor closed. The floor has 23 semi-private rooms. Doors are to be kept closed at all times, with only a few exceptions...basically only if the patient requests to keep the door open. Even if the patient is confused we are to keep the door closed, including those in observation rooms. Baker acts (involuntary psych holds), with sitters, are also to have closed doors, unless the patient is seen being combative. The nurses and PCAs do not feel comfortable closing the doors, but management and administration are very strict on this policy.
This should not apply to confused patients. How many time have I walked down the hall to do something else, just to find a patient about to fall out of the bed or about to rip out an IV. I hope they are ready for a mass influx of incident reports
geez...psych/behavioral patients, even if on a medical floor- would never close the door and leave a sitter/tech in there alone with them. People have been killed in hospitals by patients.
And come on...confused patients??
Very poor critical thinking on management's part.
In ED, we NEVER close a door alone with a pysch patient.
the wonderful thing about any press gainey scoring suggestion/ policy, is that ME, ME, I as the nurse will be the sole person that decides what is safe. Anyone whom chooses to close my patients door against my wishes will be reported to the supervisor, risk management, an incident report, in my charting and I will OPEN the door PRIOR to that and camp my hind end out in front of it to the best of my ability.
No policy will ever undermine my determination of patient safety. As long as I provide the utmost of care, I know I'll never go wrong.
alert and oriented, I was closing your door for quiet and privacy 15 years ago, didn't need a policy to over-ride or provide common sense.
I'm such a rebel, because I feel like if I had a confused patient and I was worried about their safety I'd leave the door open. I don't feel like I'd really care what the policy was, if I felt that it was in my patient's best interest I'd break the rules.
Maybe I'm unethical? Maybe I'm pig headed but I might go as far as insisting that the patient door stay opened unless somebody else wants to assume primary nursing care of the patient.
They are to be kept closed for patient satisfaction and privacy.
Then the individual patients should let their wishes be known - why does everything have to have some idiotic policy?
Next up- "Patients will be encouraged to breathe 16-20 times per minute. Nurses whose patients fall outside of these guidelines will be disciplined up to and including termination"
The hospital where I work has started a new policy to keep all doors on the floor closed. The floor has 23 semi-private rooms. Doors are to be kept closed at all times, with only a few exceptions...basically only if the patient requests to keep the door open. Even if the patient is confused we are to keep the door closed, including those in observation rooms. Baker acts (involuntary psych holds), with sitters, are also to have closed doors, unless the patient is seen being combative. The nurses and PCAs do not feel comfortable closing the doors, but management and administration are very strict on this policy.
Is anyone else doing this?
Is this safe?
MGMT and admin need to come and sit in the halls and listen for the thuds.....:) (smiling for the previous happy policy)
Ask your alert patients if they would like their door closed. If they say yes, close it and chart their request.
I would also chart that you closed the door, as per "protocol" on your confused patients to cover your behind... keeping in mind you are continuing to do your rounds.
IMO this has bad idea written all over it. i believe a+ox4 patients should have the option of keeping their door closed (or mostly closed, especially at night), but i do not think everyone should have a closed door. ESPECIALLY confused patients. doesn't that vastly increase fall risk?
Specializes in Emergency Dept. Trauma. Pediatrics.
I always ask my patients or their family if they would like their door closed. If I have a kiddo and the parent is leaving then we will require the door be left open so we can watch the child better.
On different floors I was on when I was a student if the patient was confused or something but they didn't require a sitter they could have the doors shut but usually were on bed alarms or video cameras in the room. Especially the neuro floor.
Ask your alert patients if they would like their door closed. If they say yes, close it and chart their request.
I would also chart that you closed the door, as per "protocol" on your confused patients to cover your behind... keeping in mind you are continuing to do your rounds.
Would this work for you?
Good idea. Until court. Then the responsible nurse can chart her behind off, but if it's a common sense thing, the policy can be tweaked enough to still throw you under the bus. Policies aren't for safety- they're CYA- the hospital's "A"...nobody else's. JMO :)
I offer to close the door and ask the pt's preference We have a mix of reasons why the pt does not want the door closed.
I ask so pt's feel they have a choice. I never assume preference.
Now my confused man who was moved closer to the nursing station does not get a choice. There is a reason why we moved him. I close the curtain for privacy and cause he does like to take his gown off while sleeping (per wife he slept in boxers only all his life) and it is easier to peak around the curtain.
The hospital policy per OP seems to have lost touch with how to deal with patients. It is as simple as a question to each pt and the nurses assessment regarding privacy vs safety. Why the policy?
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Mulan
2,228 Posts
I gather you work on a psych floor.
On medsurg, with all the confused people trying to climb out of bed, and the fall risks, the doors are usually left open.
Rooms are private, and if they want the door closed they can have the door closed.