What am I missing?

I've guessing section means to do an involuntary commitment to a psych unit?

Lotsa questions? What was the resident's background? History of physical aggression? Behaviors? Was this random or something that escalated? What precipitated this act? Med changes? UTI? What did his care plan say? Was it being followed or addressed before? Was this resident a danger to himself or others?

By no means should it be "swept under the rug". An event report should have been initiated and based off of the questions above, we would call our crisis team (county offers psych services) and then proceed from there.

Yes invol. commitment for 72 hrs.

Dementia with disturbance, depression with mood disorder, anxiety.

No UTI, yes has done it before.

The other resident was laying in her bed doing her "usual" which consists of yelling a lot.

I'm not sure about the rest as he wasn't assigned to me and it was my 3rd shift at this facility, I contacted the director and the MD who both decided he needed to be sent out on a psych hold.

I"m new to this type of population, have some experience with dementia but we have many ambulatory residents who can't be monitored 24/7. It's a locked unit.

You're not missing anything at all. You did everything you should have should have done by calling the DON and following her directions from there. It wasn't your decision to send the resident out for a psych hold, it was the MD. That wasn't a bad decision, especially as this resident already has a history with resident to resident aggression. Where I work this type of resident would return to the facility under a strict one to one with staff until alternate placement can be found. I can say from experience that this can take awhile so it is definitely a strain on staffing covering one resident for one to one care for potentially weeks.