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Purpose: To establish staff guidelines for the management of patients in need of a psychiatric assessment that will help ensure the safety of patients and staff in the Emergency Department.
1. Triage of patients with psychiatric complaints will be done expeditiously.
Patients with suicidal or homicidal thoughts; those involved in violent altercations before coming to the ED, those who verbalize threats, or those who are psychotic will be classed as TRIAGE CAT I and placed immediately and have a sitter assigned. At no time during the handoff between triage staff or ambulance staff to primary staff will the patient be left alone. At least two staff members, preferably one a security guard and one ED staff member, will disrobe patient. (All Peds patients who meet these criteria will be assigned to the Main Room.)
Patient with psychiatric complaints and who are not suicidal or homicidal may be classified as TRIAGE CAT II but need frequent re-evaluation every 60 minutes and should remain in sight line of staff. (Pediatric patients who meet these criteria will be evaluated for safety in Pediatric ED and, if necessary, transferred to the Main Room through the coordinator.) Preferred placement of these patients is in room 10 or 11 in the Main Room.
2. All patients presenting for a psychiatric assessment will be totally undressed upon room placement, and clothes and personal belongings will be secured in department lockers.
Any psych patient or those with alcohol or substance abuse, those brought involuntarily by family or police, or those expressing suicidal ideation or homicidal thoughts will have security present to assist with disrobing and placing patient in a gown.
All patients’ belongings will be searched by security for weapons. All medications will be secured and removed. If patient is admitted and meds are unable to be sent home, forward to pharmacy at the time of admission.
3. Preferred location for those needing a patient safety evaluation is Room 10 and 11 in the Main Room. If those rooms are unavailable, the coordinator will assign another appropriate room with immediate "sitter" observation. Procedures for disrobing and evaluation will occur quickly. This assessment and evaluation is not dependent on room assignment.
All belongings will be bagged, labeled, and removed to department lockers where patient/family is not allowed easy access. Never give clothes to family prior to completing evaluation. Security staff will secure any weapons found. Patient’s belongings will be transferred with them upon admission or returned upon discharge. CONSIDER SECLUSION for those patients who were involved in significant violent events prior to coming to the ED or who exhibit threatening behavior or language.
4. An assessment for safety and cooperation needs to occur within the first 15-30 minutes the patient is in the room. It is preferred that psych liaison staff participate in this assessment with the RN or MD. If they are not immediately available for this assessment, they will evaluate the patient and communicate with the primary RN within 45-60 minutes.
5. Medical evaluation of the patient needs to occur within the first 30-45 minutes the patient is in the department.
The Emergency Department physician or mental health liaison staff may request the following tests upon further evaluation:
6. A psychological assessment will be conducted ASAP by the psych liaison staff to determine continued safety and disposition. Need for a sitter or restraints may change based on this assessment. Goal is to have assessment under way within 45-60 minutes of patient’s arrival in ED.
Assessment will include but not be limited to:
7. Based on the evaluation, and consultation with the Emergency Department physician, patient may require sitter, seclusion, and/or medication or physical restraints to maintain patient and staff safety. Seclusion and restraints will be carried out in keeping with the hospital administrative policy on restraints.
8. Any patient deemed to be at risk for violence, elopement, or suicide requires continuous observation while in the Emergency Department.
9. Continuous observation responsibilities are as follows (continuous observation may be done in person or via video/auditory monitoring):
10. Key role and responsibilities for observers/sitters:
11. Staff safety needs to be maintained.
NO staff entering seclusion rooms should have objects that could be used to hurt them, i.e., scissors, hemostats, etc. Staff need to secure stethoscopes, pens. etc., and take as little as possible into the room. When the patient has exhibited violence toward the staff, security or police also should be present when staff members enter the room.
Northwest Community Hospital has zero tolerance for abuse, or threats of abuse, against any employee. All abuse or threats of abuse need to be documented in patient’s record and via occurrence reports.
If patients injure employees, they have the right to notify the police and press charges. Employees need to complete form for work-related injury.
If a patient injures another patient, Security and Risk Management will follow up as necessary with authorities.
Source: Northwest Community Hospital, Arlington Heights, IL.