Hello all!
We often board psychiatric patients in our ER for days or longer and in the past few weeks have had an uptick of violence towards staff by patients, especially those of whom have autism spectrum disorder alongside psychiatric diagnoses. Many of these patients have also had adverse childhood experiences, such as being the victim of domestic violence, or witnessing it in the home, or other traumatic experiences. Sometimes with our patients, especially those with autism, there aren't any ideal disposition plans and where we hold psych patients is mixed with patients with just medical complaints and is not set up for much comfort or any exposure to natural light.
Is anyone able to share policies or any successful harm reduction strategies for these patients that slip through the cracks? I know that there's often not an infrastructure (inpatient, outpatient, residential, or in the community) to help these patients - and especially not in the ER - but I would love to see if there's anything we might be able to implement for staff safety and to improve the care we provide for our psych patients. We see patients with psychiatric or behavioral complaints as young as 5 and up to 18-19 (our 18 year old + patients can go to the Adult side's more comprehensive psych area, but some don't if there are no beds or if they have developmental delays or Autism).
Thanks for any fresh perspectives on this!
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Tara Doherty, BSN, RN, CPEN, TCRN
Pediatric Emergency Nurse
NewYork-Presbyterian/Morgan Stanley Children's Hospital
New York, NY
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