please feel free to comment.add or suggest and also please discuss possible questions asked by ward manager and how to answer them
Mangement plan with ward manager
First of all I would introduce myself and acknowledge that there was a serious incident on ward where one of staff member was assaulted .I understand this is difficult for you and staff as it would be helpful if you can tell me what is your understanding of what happened as It will help us to formulate a joint management plan and we would be able to discuss how best we will be able to contain situation while maintaining the safety of others and also ask about member of saff who is assaulted how is he/she and I understand that you must have followed the necessary protocol and informed the police.
Can you tell me what happened.
Then tell the summary of my assessement ,including MSE and Risk assessment
My management plan is
1-IF PT IS PSYCHOTIC AND SEVERLY AGITATED
Our aim is to maintain the safety of other patients and staff on ward.As he is quite agitated and because of current risk I would suggest him transferring to PICU and close monitoring and making staff aware of the risk and to take behavioural approach in dealing with his anger,
-First I would suggest using non drug approach to calm him like talking to him,talking calmly and avoid confrontation and would ask him hat he want and meet their needs as by doing that he will have a feeling that he is been heard but at the same time make sure the person who is talking to him protect himself by talking from distance,take panic alaram with him etc
-If non drug approach does not contain the situation then consider use of medication to calm him down ,Use RT according to local policies and guidelines ,but make sure if pt is given RT monitor his physical state including BP,Resp ,pulse and signs of neurological reaction eg acute dystonia .Rt will help him to calm down and will reduce the risk of self harm or harm to others.
-If vioelence is serious consider informing police
-There should be clear documentation in medical and nursing notes
-Medical and nursing staf should have a feedback session following emergency restraint and sedation.I would make sure that need for emotiona support of the staff member is validated/normalised and met.taff should have an opportunity to brief and reflect on the incidence to establish what worked well and what did not
-Good practice guidelines suggest community meetings to reassure patients
-I would suggest once things become better conside providing one to one time to avoid frustration to pt and provide opportunities for more activities including time out from the ward ,games and occupational therapy.
-Though pt has mental illness he has the responsibility for his action.Once he is fit to be interviewed by police and you should let staff member let press the charges so that pt is aware that such aggression would not be tolerated
-There is no place for adding /increasing medication at this point but we can consider involving forensic specialist for assessment
2-IF THERE IS ANY EVIDENCE OF PHYSICAL DISORDER/DELERIUM
Follow management of delirium
Transfer to medical ward so that pt can have access to active medical management
It is important to consider use of sedation too allow a proper examination of pt
3-IF NO EVIDENCE OF ANY PSYCHOTIC /PHYSICAL DISORDER
If pt,s behaviour is dangerous \seriously irresponsible inform security or call police to remove him from the premesis.
If he has caused damaged to staff /propert they should be cahrged