When patients keep calling 911

[JJ the crit RN]

Acute care hospital. Patient doesn't get what she wants from the kitchen: calls 911. Doesn't get a snack because we have to save them for diabetic urgencies: calls 911. Pain med is late or the doctor DCs it: calls 911. OK so what do you do? Confiscate the phone, she comes out to the hall screaming and cursing, follows staff around. Security can't do anything and police can't touch them unless it's a threat. This isn't unusual unfortunately with some of our patients. My guess is we have to put up with it forever. Thoughts?

[MSUOUgirl]

Our psych patients always threaten to call 911. We just say "this is 911". Our hospital system in Detroit has its own police jurisdiction separate from the surrounding city.

[djh123]

No advice, but sympathy. Apparently someone in my faciity called 911 last night too ... had to tell a dispatcher that I didn't know of any problem. We had someone call in a bomb threat - TWICE - quite a ways back, and another shift had to evacuate the building. I also had a resident several months ago who called 911, claimed he knew the governor, FBI, and oh yeah - another unit told me that when he was there, he called 911 and said "I was brought IN to this place in a helicopter, and I want to be picked UP by a helicopter and taken out". Uh-huh.

[Ellie G]

We were only allowed to use sitters for suicidal or homicidal ideations and nothing else.

[brillohead, ADN, RN]

I don't know any facilities that provide sitters anymore, order or not.

We were only allowed to use sitters for suicidal or homicidal ideations and nothing else.

We can use sitters for extreme fall risks, non-compliant fluid restriction patients, IV/PICC/Oxygen pullers, etc. However, more often than not, we don't have any sitters available, so we have to pull an aide off the floor to go sit instead.

[vlewis515]

911 Dispatcher working on prereqs here. We get a ton of calls from patients in hospital/specialty care. The exact wording of 911 abuse can make charges tricky and in my 13 years dispatching, my agency has only filed one case of 911 abuse. Where I live, there has to be an ongoing harassment factor. So calling on 911 (has to be on 911 line not non-emergency) everyday to tell us that we suck and we're horrible people = 911 abuse. Calling 911 for frivolous issues doesn't constitute harassment because they are "real" problems to the person calling. A PSAP also has to deal with individual city/county SOPs on providing service. Where I work, the policy is "if they ask for police/fire/EMS, they get police/fire/EMS." The city doesn't want the liability of denying service even in such circumstances.

[blackribbon]

Our hospital has a behavior contract for disruptive patients. If they don't abide by our rules for their safe care (including diet and activity restrictions), then they are saying that they are not agreeing to be treated and we can't do anything more for them and we will discharge them.

The other form I'd use is an AMA form and present it to them as an option if they are not happy with their care, diet, or restrictions, reinforcing that they are free to leave anytime they want or are not happy but to not expect to be readmitted for the same condition any time soon. (In particular, for our patients who want to leave to smoke or get high). I find when they realize that I will allow them to leave, patients often become more compliant especially when I explain the if they just leave and go back into the ER, the doctor there will see all their records of this visit and is unlikely to give them any pain meds this time around.

[blackribbon]

We use sitters all the time. We often don't have enough and an NA is forced to sit. Most of my sitters are for elderly dementia patients...though we have and sitters for suicide watch. Again, this situation would be met with a behavioral contract reinforcing that the patient doesn't have to be there and we don't have to treat them if they are not compliant with our recommendations. They are adults and free to go (assuming no psych diagnoses that remove this right).

[Joanie49]

I have actually has this happen malp. times in my hospital. Along with 911 calls I had a pt calling dating services and leaving voicemails for people to call her back at her room telephone number...........UM YA... Anyway, if somebody wont stop calling 911 we always take the phone out of their room and security will come up to "make sure they are okay" and get back in contact with police to assure safety... In my area at least, any person using 911 without an EMERGENCY can get in trouble/ even a summons to court.... If a patient was cursing and screaming in the hallway I would definitely be calling for some haldol and a consult to eval her mental state............

[Kooky Korky, BSN, RN]

Exactly my thoughts. Sounds like this PITA patient is taking up a bed that someone else might need. Call the MD and tell 'em it's time for discharge!!! Also, for patients like this, I always print an AMA form just to be prepared, and tell the patient they have the right to leave if they don't like the care they are receiving, just have to fill out a form!

Maybe they are homeless and have nowhere to really go. Or they're waiting on their check to come and want to stay in the hospital til it does.

Get the doctor to stop admitting these people.

If they are following staff around, yelling, disturbing other patients, they are indeed a threat and have earned Haldol, isolation, etc. That's assuming they don't have a legitimate c/o. Even with a legit c/o, they should behave courteously. Of course, some staff antagonize or ignore them and then all bets are off.

[Kooky Korky, BSN, RN]

911 Dispatcher working on prereqs here. We get a ton of calls from patients in hospital/specialty care. The exact wording of 911 abuse can make charges tricky and in my 13 years dispatching, my agency has only filed one case of 911 abuse. Where I live, there has to be an ongoing harassment factor. So calling on 911 (has to be on 911 line not non-emergency) everyday to tell us that we suck and we're horrible people = 911 abuse. Calling 911 for frivolous issues doesn't constitute harassment because they are "real" problems to the person calling. A PSAP also has to deal with individual city/county SOPs on providing service. Where I work, the policy is "if they ask for police/fire/EMS, they get police/fire/EMS." The city doesn't want the liability of denying service even in such circumstances.

Your city must have lots of money. PSAP?

[3ringnursing, BSN]

Sounds like a BH consult and psychological evaluation would be a good idea to discuss with the admitting provider.

I work for a large primary care organization with clinics scattered all over town, and I've taken calls from patients in SNF's calling to say they had been physically abused because they weren't allowed to go out to smoke, drink cup after cup of coffee as is their usual habit, or that the food was bad. These same patients also had been calling 911 for similar thwarted desires or perceived needs.

One patient at our health care center in particular comes to mind - she routinely calls 911 because she is confused and afraid she will sleep through her alarms alerting her to her Rx med times - one EMS I spoke with said he has been responding to her residence for YEARS. EMS have started the proper documentation, as our facility has too, but my boss has told us all that takes time to get people who are unsafe living alone through the proper channels to an assisted living facility or group home. I filed a APS form 3 weeks ago which took 2 hours of my own time after my shift ended - no one has contacted me, and the patient is still at home in what many of us deem an unsafe situation. And likely still calling 911/EMS several times or more a week.

It can be very frustrating to work with or care for patients who are inappropriate in their actions and reasoning abilities just from the stand point of the large amount of time they require. In light of the things I've seen at this particular employer over the past 3 years, not to mention the things I've seen patients do over the past 2 decades, I very much believe that there are people calling 911 inappropriately from a wide variety of settings.

[KCMnurse, BSN, MSN, RN]

My mother did this a few months after she moved into a residential care home. Her complaints ranged from straight out abuse, needing to speak to the queen, to being starved to death... Not fun for the home because the police always showed up to check things out. Perhaps this patient has a family member that can make some 'adjustments' to her phone access? I was able to get 999 blocked from my mother's landline in the home. Not sure if that is possible here in the US but worth a try if it is becoming a problem.