Don't leave a psych patient in waiting room

Patients can harm themselves or others

Psychiatric patients can leave your ED without warning or cause harm to themselves or someone else, says Nancy Bennett, RN, MSN, ED educator at The Hospital of Central Connecticut in New Britain.

"When we hear 'depression,' 'suicidal ideation,' or 'hearing voices,' we get the patient out of the waiting room and anywhere we can find that's going to be safe," she says. "Even if we don't have a bed for them, we'll put them in a chair in an area where they're watched."

The ED has a psychiatric area where patients are reassessed every four hours, including vital signs. Nursing technicians assist with vital signs, feeding, and toileting patients, remove all of their belongings, and have them change into hospital clothing that has snaps instead of strings to tie. "If a patient is of particular concern to harm themselves or attempt to leave, we have sitters who literally sit in front of them and make sure they stay in their bed and don't attempt to harm themselves," says Bennett. "We call it 'constant observation.'"

A security guard is stationed outside the ED in the event a patient exhibits out-of-control behavior. "We have cameras so security can see the area, and silent alarms in case of a patient acting out and attempting to leave or harm a staff member," Bennett reports.

If a patient comes to triage with a behavioral or emotional problem at Bixler Emergency Center in Tallahassee, FL, a psychiatric emergency response program (PERP) is triggered, with patients checked by a security officer every 15 minutes and an assessment done by a behavioral health nurse. "They assist us in determining if the patient is a danger to themselves or others," says Freda Lyon, RN, BSN, MHA, service line administrator. "Unfortunately, this does not assist in alleviating the Emergency Center overcrowding. We have six PERP beds, and six is usually never enough."