Emergency Department Care of a Long-term Patient Team
May 2018
Emergency
Patient
Emergency Department
Overlake Medical Center
Bellevue
,
WA
United States
Marie Yabut, RN; Maddie Williams, RN; John Daman; AJ Galloway; Clint Fendley; Deb Rossie, RN; Liz Bethune, RN; Leah Shepperd, RN; Laurie Lee, RN; Eric Shipley, MD; Jeff Fleming; Edie Newell, RN
We had a patient come to the ED who was not managing in his homecare setting. This patient was admitted to the floor after a day in the ED. Once on the floor, a staff member was injured. It had been decided to discharge the patient and take him back to the ED, placing him in seclusion. This patient was a 21-year-old autistic male who could pass for an NFL linebacker. It had been determined that this patient would remain in the ED until placement in the community could happen. Unfortunately, the patient had been denied at all possible placement areas including Harborview. In order for this patient to come out of seclusion, we needed to develop a plan to keep staff and the patient safe. The plan we developed and coordinated with our security partners was to move this patient to an end room in the ED and required a male ED Tech 24/7 along with security presences for the first week. We had to rearrange schedules in order to provide this 24/7 1:1 care.
Emergency Department staff like turnover and their expertise is not with caring for patients for long periods of time and the department is not set up for caring for patients for extended periods of time. For example, we do not have bathrooms in our patient rooms and we have five bathrooms total for 40 beds. It became clear to us as time went on that our long-term patient was not going anywhere any time soon. The team developed a care plan. This care plan included regular exercise and limited the number of sugary foods this patient could have. Every day, security would have designated times where they would walk this patient in order to get some exercise. Trying to get him on a sleeping pattern was a challenge. Who knew? Not us, but we all learned quickly what was needed to care for this patient. Staff purchased games and food for him. This patient's story was a tear jerker and we all felt for him. We wanted to provide better care and did the best we could considering the circumstances. With that being said, staff remained positive and willing to do whatever was needed for as long as it took. One of the things that really stood out is the staff celebrated Christmas with this patient and his family.
Staff endured physical and mental anguish during these three months. We also strived to keep him out of seclusion since he had a mindset of a five-year-old. After almost three months, we finally were able to discharge this patient to a place that would accept him.
Emergency Department staff like turnover and their expertise is not with caring for patients for long periods of time and the department is not set up for caring for patients for extended periods of time. For example, we do not have bathrooms in our patient rooms and we have five bathrooms total for 40 beds. It became clear to us as time went on that our long-term patient was not going anywhere any time soon. The team developed a care plan. This care plan included regular exercise and limited the number of sugary foods this patient could have. Every day, security would have designated times where they would walk this patient in order to get some exercise. Trying to get him on a sleeping pattern was a challenge. Who knew? Not us, but we all learned quickly what was needed to care for this patient. Staff purchased games and food for him. This patient's story was a tear jerker and we all felt for him. We wanted to provide better care and did the best we could considering the circumstances. With that being said, staff remained positive and willing to do whatever was needed for as long as it took. One of the things that really stood out is the staff celebrated Christmas with this patient and his family.
Staff endured physical and mental anguish during these three months. We also strived to keep him out of seclusion since he had a mindset of a five-year-old. After almost three months, we finally were able to discharge this patient to a place that would accept him.