Subject: Safe Initial Management of Psychiatric Patients
Policy Number: A15
Effective Date: 08/01/2002
Revision Date: 08/01/2002
OBJECTIVE
To establish safe guidelines for the management of patients with acute psychiatric illness being evaluated in the Emergency Department.
SCOPE
This guideline applies to MCG Health Inc. Emergency Services Department both Main and Pediatric. This guideline will apply to management of patients with psychiatric concerns in the Emergency Department by Emergency Department Staff and Public Safety/Security staff members.
JUSTIFICATION
Patients with a variety of psychiatric complaints present to the ED by various means. There exists a subset of these patients who are at risk of harming themselves or others and others who are at risk of eloping from the department. These guidelines will facilitate consistent management of these patients to assure the safety of the patient, as well as other ED patients, visitors, and ED staff.
GUIDELINES
All patients with psychiatric complaints should be brought back to an exam room expeditiously.
1. Patients who are referring themselves who are not suicidal or homicidal:
• May be placed into any examination room.
• Should be instructed to disrobe and don a patient gown in keeping with general ED practice for all patients.
• Clothing and belongings should be kept in the room.
2. Patients who refer themselves and express suicidal or homicidal ideation:
• Should be placed directly into an exam room.
• Public safety should be called to perform a "Terry frisk" (patting down the patient and scanning with a hand-held metal detector)**. For discretion, this should be performed in the exam room, whenever possible.
• The security and ED staff will assure that the patient fully disrobes and puts on a patient gown.
• All patient belongings will be searched by security for weapons.
• All medications will be secured from the patient and removed from the room.
• All belongings will be bagged, labeled with the patient’s name, and removed from the patient room for safe keeping where the patient is not allowed easy access to these items. This will be performed by ED staff and security personnel. All belongings will be transferred with the patient to whatever final destination he or she is transferred (e.g., admission, transfer to another facility, discharge home). This will be performed using current policies for patient belongings (see Policy A.04).
• Either family members or nursing staff should closely monitor this patient. If there is any concern expressed by the patient, family, or other staff members that the patient may elope, a sitter (family member, staff member, or police office)" should be posted in or outside the room.
3. Patients deemed by triage, or later examining staff, to be at any risk for hurting themselves or others, should be treated similarly as in Guideline 2.
4. Any patient brought in involuntarily (by family, EMT, or police):
• Will be placed into room A1. If this room is not available, the patient will be placed into another room with a dedicated sitter assigned to the room.
• "Terry frisking" will be performed routinely.
• This patient will be completely disrobed and placed into a gown under supervision.
• All patient belongings will be searched by security for weapons.
• All medications will be secured from the patient and removed from the room.
• All belongings will be bagged, labeled with the patient’s name, and removed from the patient room for safe keeping where the patient is not allowed easy access to these items. This will be performed by ED staff and security personnel. All belongings will be transferred with the patient to whatever final destination he or she is transferred (eg admission, transfer to another facility, discharge home). This will be performed using current policies for patient belongings (see below and see Policy A.04).
• The room will be locked from the outside, and the patient will be monitored closely, in accordance with hospital seclusion policy.
• Violent patients may require additional physical or chemical restraint at the order of the examining physician. This will be carried out in keeping with the hospital "restraint" policies.
5. Any medically unstable psychiatric patient:
• Will be treated in a critical care room.
• "Terry frisking" will be performed routinely as soon as medical stabilization allows.
• This patient will be completely disrobed and placed into a gown under supervision.
• All medications will be secured from the patient and removed from the room.
• All belongings will be bagged, labeled with the patient’s name, and removed from the patient room for safe keeping where the patient is not allowed easy access to these items. This will be performed by ED staff and security personnel. All belongings will be transferred with the patient to whatever final destination he or she is transferred (eg admission, transfer to another facility, discharge home). This will be performed using current policies for patient belongings (see below and see Policy A.04).
• Violent patients and/or patients threatening to leave before being fully evaluated may require verbal confrontation to calm down and/or stay. Failing this, the use of physical restraints or sedation at the order of the examining physician may be required. This will be carried out in keeping with the hospital "restraint" policies.
Patient belongings (See also Policy A.04)
• Patient belongings will be returned to those patients who are determined to be stable for discharge home.
• Patients who are admitted or transferred: Patient belongings will be transferred with the patient and handled securely by transferring personnel.
• Any weapons will be secured by public safety according to hospital policy.
** Patients will be informed that "Terry frisking" and disrobing are hospital policy providing safety for the patient, other patients, visitors, and staff members.
RESPONSIBILITY
The Department of Emergency Services is responsible for the upkeep of this policy.
These guidelines have been reviewed and agreed upon by the Department of Psychiatry and MCG Public Safety.
| Approved: | ________________________ | __________________________ | |
|
Michael Flake, RN Director, Clinical Operations MCG Health Inc. |
Michael Shafe, MD Director, Emergency Department Medical College of Georgia |
||
| Date: | ________________________ | __________________________ |
Source: Medical College of Georgia, Augusta.
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