Yelling, screaming and ducking the cranky triaged patients

one_speed · Apr 5, 2007

have you ever heard the term "Pile - On" ?

one_speed · Apr 5, 2007

I mean I don't want to give the impression to my colleagues that we look for fights up here... but when it comes down to it; protection for myself, my coworkers and my patients is a priority compared to what ever sense of entitlement some person might have. These types of patients should consider themselves fortunate that there are so many caring and professional people around that agonise over whether or not they did the right thing defending themselves against attack or abuse and whether or not the suits (hospital admin) agree with them.

Honestly I think it might be the frame of mind I have gained from my training as an RN with the Canadian Forces. We are issued side arms and rifles (we're non-combatants) to protect ourselves, our colleagues, patients, and our equipment.

Calling a "code white" or intervening before someone does something they may or may not regret, or someone get's hurt is a small step in the grand scheme of things.

Ian

teeituptom, BSN, RN · Apr 13, 2007

I think that if the initial assessment determines that the c/o is not life threatening (tooth pain), no one could fault you for releasing the patient to the street. However, lawers will sue over anything, so Chart, Chart, Chart.

So get rid of all lawyers problem solved, Is what your saying:monkeydance: :lol2: :devil:

Heather56 · Apr 15, 2007

Last night had a patient come in with a rash. brought him in out of the wr to a chair right away as I was concerned about scabies. Pt proceeded to make rude comments to me everytime I walked by him. After he had been in the dept for 20 min heard a loud voice in the wr and turned in time to see my pt, pants down and rash covered bottom displayed saying we were all idiots as he toddled out the door. hmmm

The issue of pt behavoiur and duty to treat was addressed by our nursing association recently in their magazine. They said that, although we did have a duty to provide treatment/care, we also had to consider the safety of others in the wr and of staff. In our er if a pt becomes loud and verbally aggressive or bothers other pts we call security. They will read the pt the riot act and if the pt refuses to behave he/she will be escorted off the property. This is actually quite rare as these pts do have enough sense to realize that they won't get anything if they don't behave. It's after they've been seen and d/c (after getting some ibuprofen) that they really start to scream at us but security just arrange for them to get a personal ride with the local police.

Jennifer, RN · Apr 16, 2007

The only way I feel I have a "duty to treat" an aggressive, combative, violent pt is if they are in 4 pt restraints. In triage, if a pt gets aggressive, they are instructed to leave the property, if they refuse, the police will come to take them away. If they have a true medical emergency, the police can take them through the ambulance bay, and we will put them in our psych area in restraints if necessary. I do not tolerate assinine behavior from pts in the lobby.

allnurses Guide · Apr 26, 2007

So get rid of all lawyers problem solved, Is what your saying:monkeydance:

You Shakespearian you :lol2:

teeituptom, BSN, RN · Apr 27, 2007

To be or not to be

I always carry an Uzi

bigjim · Oct 30, 2007

I called a code white at my facility and got one short fat lab guy who zoomed in like he was on speed. Notably the administration group, who are closer than the lab, didn't even send us a phoned congratulations for keeping everyone alive.

He probably went to work every night just hoping that tonight would be THE night that he would get to lay the smackdown on somebody. I'm suprised he didn't have a wrestling mask and cape on when he came a-running.

Don't get me wrong, I'm glad there are people like him who are ready to help when there's a problem, but I can't help but laugh at the visual of the chubby little guy running down the hall ready to throw down.

ERRNTraveler, RN · Oct 30, 2007

If a patient came into triage with tooth pain, then attempted to take a swing at hospital staff, I would consider that a refusal of care.

psalm, RN · Oct 30, 2007

In our tiny hospital in the sticks I triaged a woman for dental pain who had just come from another ER three towns away. They didn't give her the meds she wanted so she hitchhiked to us. she was loud and demanding, and got more so over the next 30 minutes. Security was called, and when she took a swing at him she was told to leave the facility.
So...my question is since everyone is required to have a medical screening exam if they present to triage, under what circumstances do other ERs consider a patient's behavior unacceptable and tell them to get out. If you don't kick them out how do you handle them without having everyone else waiting realize that the way to be taken back immediately is to be loud and demanding?

...are you in Michigan? I had a pt. like that who was brought up to my floor and had a hep lock for morphine IVP. She wasn't getting enuff so she ripped out the hl, got dressed, called her mom to meet her in the ER parking lot (0300), and proceeded to leave our floor. I escorted her down the elevator and out the ER, explaining to her that I just gave her the morphine and wanted to make sure she didn't collapse in the elevator or en route to ER. When we got to ER she walked out so she could smoke...2 security officers came over and THANKED me for escorting her out, as when she came in she was really looped, uncooperative and word was, she had just come from another ER. They didn't want to have to deal with her anymore.