One of the first things I do each night when I arrive at the hospital is check to see what patients I have been assigned. It's always a little bit exciting and kind of the "luck of the draw." The nurses all try to do it as evenly as possible, but if everyone is getting an admission overnight, there's really no telling how busy it will be.
Well, the other night, my old preceptor got a CRA-ZY patient. I know what you're thinking: why am I blogging about a patient who wasn't mine, that wasn't even on my unit? This patient was that CRA-ZY, that's why.
It started off similar to all our shifts. My preceptor popped over to say hi, and told me she had a crazy one, then I didn't see her for several hours. At some point overnight, I popped over to her side to say hi, and she updated me.
At that point the patient had locked them self in the bathroom and was refusing to come out. Obviously, this is a problem, but in this patients case, it was a bigger problem then normal because they were seriously sick. In fact, the doctor was on the floor discussing whether or not this patient was going to have to go to ICU.
How was this patient able to lock themselves in the bathroom if they were that sick, one might ask? Well, many patients around the hospital have chronic conditions, and function fairly well with lab levels that would have you or I flat on our backs. It's one of the human body's amazing coping mechanisms.
Anyway, after about 45 minutes of persuasion, and being unable to convince the patient to come out of the bathroom, they unlocked the door and got the patient some vital IV fluids.
At some point during these IV fluids, the patient disappeared. Completely. Off the floor, off the heart monitor at the desk. This was when I started helping. I went to look in all the normal hiding places while my preceptor called security. Not surprising to anyone who works at my hospital, we have a written protocol for situations such as this.
And, yes, you read correctly "normal hiding places." After working here for a matter of weeks, you learn that patients have places they like to go to smoke and such. When they disappear, you go look in those places to see if you can convince them to come back to their rooms. I live a charmed life at this hospital, let me tell you.
So, the patient is essentially a ticking time bomb due to not only their chronic condition but very serious blood clots as well. Additionally, they have some serious IV fluids hanging that require constant monitoring.
How did the patient leave you ask? Well, we have other patients to take care of, and we can not force a patient to stay in their room. That is a form of restraint, and is against a nurses scope of practice.**
**Unless the patient is a risk to harm themselves or others. In which case, the doctor has to put in the appropriate restraint orders, etc.
So, in cases like these we do a lot of "education." Like "Patient, you have the right to accept or refuse any medical treatment we offer you. However, if you don't have this medication, XYZ may happen." (I usually say like "explosive diarrhea" or something equally terrible like "death" which is never outside the realm of possibility around here, especially when the number one complication of a condition, is actually, death.) Anyway, this patient had been educated out the wazoo and still walked off the floor.
Protocol was followed, and excessive documentation was commenced.
Eventually, the patient showed back up. In fact, I saw them walking down the hall and followed them to make sure they made it back to the room. Clearly, the patient was still alive, but there were a few minutes there where we wondered.
Around here, patient assignments really are the "luck of the draw."
