Pt took drugs during transport

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johnhenry

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During transport of a combative behavioral patient, the man pulled out a bottle of nicotine lozenges and tossed a couple in his mouth. I never took my eyes on his during txp, I attempted to take the bottle from him and he started hitting me and became more angry. In short, he took the drugs (unknown if they are really lozenges) during transport. I made sure to tell the MD and RN at the hospital. 1) I feel like I messed up pretty bad, 2) how should I document that despite trying to wrestle the pt he still got the pills into his mouth
 
It's probably better to ask your supervisor or clinical education department how you should document it. Generally, you want to be honest about it, but they may want an incident report or something like that.

"During transport, the patient ingested lozenges. Unknown what they contained. Attempts to stop the patient were unsuccessful. Notified receiving MD and RN." Something plain like that I imagined. You could add how did he change, if at all, after taking them.

Things like this happen. We try our best to control it, but sometimes we can't. Mistakes happen and that's OK.
 
johnhenry said:
During transport of a combative behavioral patient, the man pulled out a bottle of nicotine lozenges and tossed a couple in his mouth. I never took my eyes on his during txp, I attempted to take the bottle from him and he started hitting me and became more angry. In short, he took the drugs (unknown if they are really lozenges) during transport. I made sure to tell the MD and RN at the hospital. 1) I feel like I messed up pretty bad, 2) how should I document that despite trying to wrestle the pt he still got the pills into his mouth
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How do you think you messed up? I mean, how much force are you expected to use to get pills out of his hand? O2 bottle? Halligan tool?
 
he's a combative psych patient... did the cops search him before he got in the ambulance? if they didn't, did you check him for weapons? if it was in a pill bottle, a patdown should have alerted you to it. if not, ehh, that's an issue, but the fact that you didn't call for law enforcement when the combative patient started hitting you is a bigger concern.

as for how to document, speak to your supervisor.
 
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That happened to me once but the patient used a vape cigarette. I only realized it because he became fairly mellow after hitting it and I was like “ohhh..”

Wasn’t a big deal.. I kept an eye on him for the (now pleasant) trip and let the ER know.

unless you knew them to be drugs and allowed him to take them, you didn’t mess up..
 
Can't physically stop a patient beyond what you tried; anymore can be assault and battery on your part, even though he assaulted you too.

I would have called for the police too
 
You did not mess up, just document what happened. Patient took two nicotine lozenges before I could stop him. End of story.
 
Stuff happens, we had a guy swan dive on to the pavement from the back of one of the ambulances doing 60 mph.
 
In my state, if they‘re a 9.41, the police clear them. If they’re not violent and go peacefully, we leave them be and just monitor. If a pt pulls out lozenges, we try to determine what they are and just document it. If you explain we just need to note it as it may affect care, they tend to be ok with letting you see the package and assume they’ll get it back. Be sure to give it back as trust is an important tool in effective care and make sure to include it in your PCR, MIST and oral TOC reports.

Pts do stuff we don’t catch until it’s too late. Just be sure to document. Stuff happens, relax.
 
If this was a person from PD custody, PD should have shook him down better. With that said I would never get into a physical altercation with a psych patient. I think you were fine. Just document it and notify your supervision or CES department on how it should be properly handled.
 
Old Tracker said:
Stuff happens, we had a guy swan dive on to the pavement from the back of one of the ambulances doing 60 mph.
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A number of years back, AMR Alameda County had a patient jump out of the back of the ambulance on highway 580 when they were going about 60 miles an hour. They did not restrain this person who was on a 5150 hold.
 
Did they at least tuck and roll? I had a psych PT jump out of our ambulance one time who was on non voluntary. They weren't on any restraints at the hospital. Luckily we were at a red light.
 
Restrain your combative patients. The inconvience and their embarrassment is not worth you getting hurt over.

You say he's a psych, but was he on a hold, in custody? If so, that does change things. If not, my attempts to stop a patient doing anything are, "That's not the best idea because of: x, y, and z. If they comply, great, if they don't... I tried.
 
Fun thing: which psych patients do you restrain? I transported 2 last week, both calm. but both had the chance to become combative.
The 1 that became combative was the non psych patient who was in SVT that I fixed, he slept for 80 minutes of the transport (130 miles) and after one pothole he woke up swinging.
So do we restrain all patients/
 
johnrsemt said:
Fun thing: which psych patients do you restrain? I transported 2 last week, both calm. but both had the chance to become combative.
The 1 that became combative was the non psych patient who was in SVT that I fixed, he slept for 80 minutes of the transport (130 miles) and after one pothole he woke up swinging.
So do we restrain all patients/
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No...but you do sit at the head of the stretcher...
 
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