Violent patients on inpatient

[Stagg737]

We aren’t soldiers (but please ask one if they feel wronged when their fellow service member is pregnant and cant be near a combat zone.) We are extremely privileged people who have staff that take on violent risk for us. Thats their job. Lets not pretend to be something we’re not.

This is true, but let's also not understate the risks to physicians both inpatient and outpatient. Yes, nurses and techs are much more likely to be assaulted, but psychiatrists are still the second most likely physician to be assaulted behind EM. I know several residents and attendings who have been assaulted or had an attempted assault (myself included) directed towards them. One of my attendings from med school was stabbed when he was in residency. My program had a resident who was killed while evaluating a patient in the ER (in the 90's I think). So no, we're not police or military, but we do deal with more significant hazards than most people have to deal with.

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[the5thelement]

Its a tough game. Patient charged in death of doctor he tackled at Timberlawn mental hospital

 

[Mad Jack]

There's the whole statistic that psychotic or mentally ill patients are more likely to be the victims of crime than to be violent compared to gen pop, and stigma around mentally ill psychotic patients and being violent, and I thought I'd point out for anyone reading this that didn't know, the caution we're talking about having on inpt unit is different than the assumptions you need to make when someone tells you they've been treated for psychosis in the past, or Aunt Mabel's depression diagnosis, or you see someone walking down the street talking to themselves.

When someone has demonstrated they are a danger to themselves or others to the point of being hospitalized, and lost touch with reality, an abundance of caution is needed.

That said the caution level a female psychiatrist takes when it's just them vs they have a big pregnant belly weighing them down is different.

For the person mentioning mouths to feed, there's a difference to being beaten up and not able to work for money, and actually bringing in one of those mouths to feed into the exam room with you to see the violent patient.

Also there comes a point where the risk isn't even the baby dies. After a certain number of weeks resuscitation can mandatory for a premature baby. So whatever damage is done to it, both the child, parents, and siblings may be living with forever.

It's not worth it. Lay low after 22 weeks. If you trade, maybe don't make it a fair trade, take on more than one patient in exchange, take on someone extremely malignant but not violent, like the other doctor's nightmare patients. There's usually other nightmare patients on inpt than just violent psychotic ppl.

Also lol to the person saying you can avoid a kick to the uterus. Not saying this doc would get in a chair to see the patient, but you ever see a pregnant woman struggle to get out of a chair or get up from kneeling?

I'd like to see someone strap a 20 lb backpack to the front of them and see them try to defend it against some kicks. I'd pay money to see it.

So the thing people don't mention about that statistic is this: individuals with schizophrenia are more likely to be the victims of violence than to be perpetrators of it, but they are significantly more likely than the general public to commit acts of violence. Patients with dual diagnoses of psychotic disorder and substance use disorder are far, far more likely than the general public to commit acts of violence by several orders of magnitude

Mental illness and violence - Harvard Health

Public opinion surveys suggest that many people think mental illness and violence go hand in hand. A 2006 national survey found, for example, that 60% of Americans thought that people with schizophrenia were likely to act violently toward someone els...

www.health.harvard.edu

On the inpatient unit you are, by definition, not seeing stable patients. With schizophrenia, the most dangerous patients are young men with concomitant substance use who are nonadherant with treatment. All of those boxes tend to be the ones that patients are more likely to check off if you're seeing them as an inpatient. Psychiatrists and those in mental health are the second most likely to be assaulted by their patients and the most likely to be murdered by them by an order of magnitude over the next leading field, and perpetrators tend to be young men with psychosis that use a firearm at the office or at the home of the decreased.

I guess the point of all of this is that 1 in 4 of your dual diagnosis patients and 1 in 20 of your bipolar and schizophrenic patients will have a history of violent behavior. Knowing risk factors for violence, being proactive in setting limits, and creating a setting that is physically conducive to safety are important in making sure you and the staff you work with don't become statistics.

 

[Mad Jack]

This is true, but let's also not understate the risks to physicians both inpatient and outpatient. Yes, nurses and techs are much more likely to be assaulted, but psychiatrists are still the second most likely physician to be assaulted behind EM. I know several residents and attendings who have been assaulted or had an attempted assault (myself included) directed towards them. One of my attendings from med school was stabbed when he was in residency. My program had a resident who was killed while evaluating a patient in the ER (in the 90's I think). So no, we're not police or military, but we do deal with more significant hazards than most people have to deal with.

We are the second most likely to be assaulted, but the first most likely to be killed.

 

[Candidate2017]

What he’s saying is spot on..if your wife is pregnant she can choose to not work but I’m not seeing her violent patients because she’s pregnant..

Exactly. If someone chooses to work on an inpatient unit, then that is their choice. They don't get to pull the "pregnant card" (or any other card) to hand off psych patients because they are uncomfortable or whatever. I've seen lots of nonsense like, "Oh hey, mind if I switch this [agitated, violent] patient with your [sweet little] patient, because you work with a lot of psychotic patients?"

Anxiety and depression clinic, cash chakra aryuvedic clinic, telepsych, stay at home spouse, unemployment, etc. These are some of the many options if one is discomfited by the inpatient milieu.

 

[Candidate2017]

It is the courteous thing to do for your colleagues. You should look out for each other when you're in need because no one else will. Maintaining a good relationship with your peers is the difference between long-term misery and career satisfaction

But when people are telling OP to dump her patient on to someone else, that's not looking out for a colleague. That's just dumping a patient you don't want to work with. In any event, what is there to look out for? This situation just sounds like another agitated patient demanding to see the doctor and rattling the staff in order to get to the doctor. How has OP not dealt with this literally a thousand times already in residency?

 

[michaelrack]

We roll the dice. These types of patients are not risk free. OP could be beaten to a pulp. But her having a fetus doesn't warrant shirking the risk on to someone else, Everyone is valuable. Who's to say the Dr taking this patient off her can also be beaten to a disabled pulp, while having 5 mouths to feed?

We do roll the dice. I personally have been beaten to a pulp by a patient. However, I would take a patient from any female doctor (especially if it was my wife ), who felt threatened.

 

[birchswing]

We do roll the dice. I personally have been beaten to a pulp by a patient. However, I would take a patient from any female doctor (especially if it was my wife ), who felt threatened.

Would you not extend the same courtesy to an effeminate male colleague?

 

[michaelrack]

When conditions are stirred up or patients seem agitated on our "acute" unit (even if my patient seems ok), I talk to the patient from behind the nurse's desk

 

[michaelrack]

Would you not extend the same courtesy to an effeminate male colleague?

At my main facility I don't have any effeminate male colleagues, but I guess I would consider it if I got such a colleague.

 

[Mad Jack]

But when people are telling OP to dump her patient on to someone else, that's not looking out for a colleague. That's just dumping a patient you don't want to work with. In any event, what is there to look out for? This situation just sounds like another agitated patient demanding to see the doctor and rattling the staff in order to get to the doctor. How has OP not dealt with this literally a thousand times already in residency?

Oh I was more speaking in general. It's common courtesy. As to how OP didn't face this, hard to say, but that is why she is here. She is asking for guidance.

 

[Wardles888]

Thanks so much everyone for all of the comments! A lot of great advice here.

I didn’t expect this to turn into an ethics of pregnant women transferring patients debate, however since it has I’ll throw in my opinion. Obviously it’s a case by case basis (and I wasn’t thinking of it for this patient) but I recall in residency, a co resident got lunged at by a patient and fell against a wall. She had some bruises but was otherwise fine (although emotionally rattled). I can’t imagine having that happen to me in my third trimester and potentially losing the baby. Here is another example: as a pgy2 I got chased by an angry 300 pound psychotic patient. I quickly ran to the nursing station and was fine. I’m certainly not capable of running like that currently (I’m waddling around). These are examples of situations where a patient interaction with a non pregnant provider is uncomfortable but possibly fatal for a pregnant provider.

 

[GUH]

I wouldn't have a problem covering this patient for a pregnant colleague (or anyone really as these patients really interest me), but assuming your statement is true then why would a pregnant physician need coverage? If the situation is so safe this entire conversation is irrelevant.



You can snow chemically sedate someone with high doses of antipsychotics, benzos, and benadryl, but sedating someone is not the same as treating them. It can take weeks for antipsychotics to actually improve their psychotic state if that is the underlying cause of their aggression. You can constantly chemically sedate them until their psychosis resolves, though this would pretty much be against standard of care in almost all situations.

I disagree that sedating an aggressive patient with a history of violence until the psychosis resolves would necessarily be below the standard of care.

 

[Stagg737]

I disagree that sedating an aggressive patient with a history of violence until the psychosis resolves would necessarily be below the standard of care.

So chemically sedating someone for 2+ weeks even after aggressive statements and behaviors have resolved in the first few days meets standard of care?

 

[Old&InTheWay]

I disagree that sedating an aggressive patient with a history of violence until the psychosis resolves would necessarily be below the standard of care.

Isn't sedating an aggressive patient while waiting for the psychosis to resolve equivalent to not performing blood letting on a patient with a humoral imbalance and expecting them to get better? How is the psychosis supposed to get out?

 

[GUH]

So chemically sedating someone for 2+ weeks even after aggressive statements and behaviors have resolved in the first few days meets standard of care?

not if the aggression and agitation have resolved. That doesn't sound like the situation that the OP is describing though.

 

[GUH]

Isn't sedating an aggressive patient while waiting for the psychosis to resolve equivalent to not performing blood letting on a patient with a humoral imbalance and expecting them to get better? How is the psychosis supposed to get out?

I'm not quite sure what you're getting at but when dangerous behaviors are present (or imminent), sedation to prevent injury is a reasonable course of action.

 

[Stagg737]

not if the aggression and agitation have resolved. That doesn't sound like the situation that the OP is describing though.

I think some wires got crossed somewhere. I wasn't talking specifically about this patient in the previous post, just the concept of sedation vs. treatment (which can go hand in hand but are not the same thing imo).

 

[GUH]

I think some wires got crossed somewhere. I wasn't talking specifically about this patient in the previous post, just the concept of sedation vs. treatment (which can go hand in hand but are not the same thing imo).

okay yes we agree on that

 

[Old&InTheWay]

I'm not quite sure what you're getting at but when dangerous behaviors are present (or imminent), sedation to prevent injury is a reasonable course of action.

I was getting at the fact the the discussion had become a bit absurd and was trying to contribute to the absurdity.

 

[Mad Jack]

I think some wires got crossed somewhere. I wasn't talking specifically about this patient in the previous post, just the concept of sedation vs. treatment (which can go hand in hand but are not the same thing imo).

Yeah, I was confused at his statement as well. A one time hit of sedation is one thing, but the doses you need to sedate someone that is violent can put a patient at high risk for aspiration and pneumonia if you're loading them up every day

 

[birchswing]

This is a bit of a derivation, but I am curious if you all have ever seen Nuedexta given to agitated/aggressive patients in inpatient facilities? This is not a personal medical question for me. Not a drug I use, want to use, or am indicated for in any way. It's a drug I have found immensely curious, however, because of how cheap its constituents are, how expensive the combined product is, and then what appears to have been a rash of what has been called inappropriate prescribing across nursing homes where it was used off label (or a fake PBA diagnosis was created) to treat aggression. I've been curious as to whether it actually worked for those patients and the offense was using it off-label or if it was both that if the crime was it both being used off-label and not working. The stuff about "snowing" patients is what made me think of it.

 

[Stagg737]

This is a bit of a derivation, but I am curious if you all have ever seen Nuedexta given to agitated/aggressive patients in inpatient facilities?

No

 

[clausewitz2]

Our geri floor used off-brand nudexta sometimes (the generic components in more or less the same goofy ratio as in the combined product). Was not hugely useful but spared a gentleman from receiving palliative sedation who was quite demented and spent all day every day sobbing hysterically.

 

[birchswing]

Our geri floor used off-brand nudexta sometimes (the generic components in more or less the same goofy ratio as in the combined product). Was not hugely useful but spared a gentleman from receiving palliative sedation who was quite demented and spent all day every day sobbing hysterically.

I got the drug approval package for Nuedexta and at one point read it all the way through. It was interesting to see how involved the FDA is in drug development. It was the FDA who preemptively actually suggested the lower dose of quinidine than was originally being tested after telling them it wasn't likely to be approved at the higher amount but that they thought the lower amount would still be effective for blocking the metabolism of the dextromethorphan. I was surprised and a bit annoyed at the level of cooperation. It seemed like handholding to me. Meanwhile they have to be petitioned by Valisure every few months to get dangerous products off the market, and Valisure is treated like dirt by the FDA (Valisure is a private company that does what most people think the FDA does but doesn't: it tests drugs).

 

[MedLife20]

Back hand them and tell them they met the hand of gawd.

 

[futuredo32]

I worked as a locums moonlighter at a hospital that didn't take patients with a history of violence. I am currently working as a locums doing half inpatient and half outpatient. They take ANYONE and a lot of patients are extremely violent, we use IMs prn ASAP, but physical damage often happens before they can be given. I had a patient who was verbally escalating and I was almost out of the room and then a nurse came in to "help" and he had me in a head lock and scratched me quite a bit. I was in shock and after a few minutes, others came to help. I now take a patient care tech in to see any patients who have been violent or have a history of violence. I am hoping to become pregnant soon and will DEFINITELY be bringing a patient care tech into the evaluation room with me if I have any concern. The patient who attacked me was elderly and bone thin. Don't be afraid to ask for help. Your safety and that of your soon to be born child matters too.

 

[RevDO]

So many of you are sharing stories of being attacked by patients. I asked my preceptors about this and they said its not something they really deal with/worry about and told me not to worry about it. I'm starting my psychiatry residency this summer but if I get attacked I'm not sure I would be able to provide quality care to these patients or continue working at all in the environment. How do you all find it possible to continue working after an incident like that?

 

[robellis]

So many of you are sharing stories of being attacked by patients. I asked my preceptors about this and they said its not something they really deal with/worry about and told me not to worry about it. I'm starting my psychiatry residency this summer but if I get attacked I'm not sure I would be able to provide quality care to these patients or continue working at all in the environment. How do you all find it possible to continue working after an incident like that?

Whether you’ve been attacked or not should not really change your perspective rationally speaking, the risk is the same whether it’s personally happened to you or not so it’s a matter of being ok with the risk, we’ve accepted the fact that we deal with sick people who sometimes are violent and may attack us, that’s just part of the job description, if you are absolutely not willing to tolerate any risk of being hit there are other jobs where the risk is much lower that one can consider

 

[Bartelby]

My incident (a patient trying to kick me and then chucking water at me) was pretty minor. I told the hospital police not to bother with pressing charges and let my shirt dry off as I went ahead with other consults! I think my experience is much more common than being seriously attacked.

As for how to deal with it keep in mind:
1- do not magnify the risk to something it isn't. These attacks do happen, but they are quite rare. Many people practice for decades without any serious physical violence/injury directed against them.

2- Don't get complacent. Pay careful attention to the patient, especially in highly charged or higher risk situations (intoxicated, severely psychotic, in crisis, a patient you don't know, a patient with a history of violent and/or disruptive behavior, holding limits that will enrage a patient, etc). Listen to your gut and if you feel uncomfortable leave the situation. You can return later once the patient has had a chance to calm down, and you can return accompanied by security or other staff where appropriate.

Keep in mind that you can't sustain a rewarding practice if you are afraid of your patients. Cultivate good, trusting relationships wherever possible and exercise appropriate precautions where a good, trusting relationship is not possible.

 

[calvnandhobbs68]

My incident (a patient trying to kick me and then chucking water at me) was pretty minor. I told the hospital police not to bother with pressing charges and let my shirt dry off as I went ahead with other consults! I think my experience is much more common than being seriously attacked.

As for how to deal with it keep in mind:
1- do not magnify the risk to something it isn't. These attacks do happen, but they are quite rare. Many people practice for decades without any serious physical violence/injury directed against them.

2- Don't get complacent. Pay careful attention to the patient, especially in highly charged or higher risk situations (intoxicated, severely psychotic, in crisis, a patient you don't know, a patient with a history of violent and/or disruptive behavior, holding limits that will enrage a patient, etc). Listen to your gut and if you feel uncomfortable leave the situation. You can return later once the patient has had a chance to calm down, and you can return accompanied by security or other staff where appropriate.

Keep in mind that you can't sustain a rewarding practice if you are afraid of your patients. Cultivate good, trusting relationships wherever possible and exercise appropriate precautions where a good, trusting relationship is not possible.

Yes, holding limits that will enrage a patient makes up a significant proportion of violence towards doctors, especially with controlled substances and especially on outpatient where this ends up usually happening.

 

[SeniorWrangler]

So many of you are sharing stories of being attacked by patients. I asked my preceptors about this and they said its not something they really deal with/worry about and told me not to worry about it. I'm starting my psychiatry residency this summer but if I get attacked I'm not sure I would be able to provide quality care to these patients or continue working at all in the environment. How do you all find it possible to continue working after an incident like that?

Practice situational awareness and don’t take a lot of chances. If you’re going to be telling an acutely manic person they have to stay in the hospital, get someone to come with you. We’re not cops.

 

[FlowRate]

Practice situational awareness and don’t take a lot of chances. If you’re going to be telling an acutely manic person they have to stay in the hospital, get someone to come with you. We’re not cops.

One of the few times a patient tried to attack me it was this exact situation. But I could tell she was trying to get as close to me as possible while I was setting up the interaction and she had already been irritable/agitated prior. So I met with her in the common room with other staff around and furniture between us, which gave me time to react (run) when she came after me.

 

[Sushirolls]

So many of you are sharing stories of being attacked by patients. I asked my preceptors about this and they said its not something they really deal with/worry about and told me not to worry about it. I'm starting my psychiatry residency this summer but if I get attacked I'm not sure I would be able to provide quality care to these patients or continue working at all in the environment. How do you all find it possible to continue working after an incident like that?

To reference classic Americana, when you get bucked off the horse you get up, brush yourself off, and saddle back up.

 

[mojetter]

This may sound controversial to some but I trained in Baltimore and worked as attending too, lots of threats and some who would attack patients or nurses although typically an attack amounted to a push or a cup thrown etc

So for delusional patients Id always ask myself if there was any reason to believe that patient would improve (by chart review and collateral) with more inpatient tx, if the answer was no then id see if the patient would cooperate with a discharge plan on the condition if they did not we could not discharge them ( which was kind of a bluff)...often the delusional patents would still be delusional weeks later no matter what

For the anti-socials and drug seekers, they HATE going to jail and as much as we hated to press charges they were aware that charges could and would be made for assault which worked 90%+ of the time...also again see if discharge was an option ASAP

{Intellectual disability, TBI, or neurocognitive d/o} + violence = discharge, they rarely improved

In the situation where there was a manic or psychotic aggressive patient we would medicate at every opportunity to reduce their symptoms and also dose medications tid so they always had some coverage ...also utilize the pm dosing for heavier doses so theyd sleep (which improved the general milieu from getting rowdy because of the agitated patient)

last consider that haldol 2.5mg bid for example is inappropriate...use higest doses that address symptoms w/o oversedating patient or causing any adverse side effects..and document, document document...especially document QTc, EPS, vitals, wbc, lack of NMS, lack or serotonin syndrome, nurses notes, tech's notes, lack of sedation

Keep conversations to a minimum and agree unless there was an acute issue, no talking to patient and redirecting over and over and over....patients really get frustrated by being told no multiple times in a day

 

[birchswing]

Some of what you all say about interacting as little as possible and not talking to a person who can't agree with you actually parallels a bit what scientologists voluntarily agree to when they enter in lieu of psychiatric treatment, except that they aren't given drugs:

Introspection Rundown - Wikipedia

en.wikipedia.org

They basically agree to be held prisoner instead of medical treatment) (before such a break takes places) and are isolated until they can improve.

I don't say make the comparison as a criticism. It just jumped out at me.

It's probably a pretty basic principle so maybe not anything too profound in seeing the similarity.

 

[mojetter]

Some of what you all say about interacting as little as possible and not talking to a person who can't agree with you actually parallels a bit what scientologists voluntarily agree to when they enter in lieu of psychiatric treatment, except that they aren't given drugs:

Introspection Rundown - Wikipedia

en.wikipedia.org

They basically agree to be held prisoner instead of medical treatment) (before such a break takes places) and are isolated until they can improve.

I don't say make the comparison as a criticism. It just jumped out at me.

It's probably a pretty basic principle so maybe not anything too profound in seeing the similarity.

You took one point completely out of context

I never said ignore the patients...I instead ask the about their family, their interests, or their basic care needs

Not sure what point you're trying to make

 

[birchswing]

You took one point completely out of context

I never said ignore the patients...I instead ask the about their family, their interests, or their basic care needs

Not sure what point you're trying to make

It wasn't your post in particular. I think a lot of posts said to some effect that it's better not to poke the bear essentially, and that's what I was responding to. It was a parallel track I had in my mind when reading this thread a couple of weeks ago I think. I haven't been here in a while. And when I came back to peruse it came to mind.

I'm not sure that I had a point per se, as much as a musing.

I guess if I were forced to expound on it, it really isn't anything more than it's kind of interesting how two diametrically opposed institutions have somewhat similar ideas.

But maybe it's more accurate to say what scientology does is closer to what psychiatry used to do with the rest cure. It's hard exactly to say what happens with scientology because it seems like the only known case is where Lisa McPherson died.

This was not a thought I had when I posted it, but at one time Dianetics was so mainstream, it's not inconceivable it could have become appropriated by mainstream medicine (like other movements such as 12 step have been). And in fact one of the aims of L Ron Hubbard was to have dianetics accepted by psychiatry. I don't know if there was ever any serious consideration given to it. So it's a bit interesting to the extent they are splinter groups to see how they diverge and do or do not remain similar.

Anyhow, I guess I just thought it was interesting with people talking about patients in psychotic states and what to about them and an organization that is so anti-psychiatry has spelled out what to do with psychotic people, as well. The fact that they even use the same language is interesting because in scientology it's verboten to use words like depression, but for some reason they consider psychotic acceptable.

 

[Liquid8]

Some of what you all say about interacting as little as possible and not talking to a person who can't agree with you actually parallels a bit what scientologists voluntarily agree to when they enter in lieu of psychiatric treatment, except that they aren't given drugs:

Introspection Rundown - Wikipedia

en.wikipedia.org

They basically agree to be held prisoner instead of medical treatment) (before such a break takes places) and are isolated until they can improve.

I don't say make the comparison as a criticism. It just jumped out at me.

It's probably a pretty basic principle so maybe not anything too profound in seeing the similarity.

One can engage with psychotic patients, but decisions by clinicians to disengage are taken in the context of various risk factors.

For the medical professional, isolation isn’t an alternative option that replaces medical treatment. Like the case described in the Wikipedia link, someone in a severe psychotic state may refuse food and drink, placing them at physical risk and it would be unethical to leave a patient in that state when there is a suitable biological treatment option available.

There are usually laws regarding provision of least restrictive treatment options for involuntary, so an oral treatment that will usually be offered before escalating to things like calling security guards, 4 point restraints and injections. Often courts or tribunals can become involved in hospitalisation and treatment decisions which is also designed to provide independent oversight.

 

[Ceke2002]

One can engage with psychotic patients, but decisions by clinicians to disengage are taken in the context of various risk factors.

For the medical professional, isolation isn’t an alternative option that replaces medical treatment. Like the case described in the Wikipedia link, someone in a severe psychotic state may refuse food and drink, placing them at physical risk and it would be unethical to leave a patient in that state when there is a suitable biological treatment option available.

There are usually laws regarding provision of least restrictive treatment options for involuntary, so an oral treatment that will usually be offered before escalating to things like calling security guards, 4 point restraints and injections. Often courts or tribunals can become involved in hospitalisation and treatment decisions which is also designed to provide independent oversight.

^^^ Pretty much all of this. Just before my Mum's diagnosis of dementia was confirmed she had to be placed on an involuntary hold under the mental health act. The first few days of her initial admission to hospital she did have a couple of code blacks (imminent risk to self or others) called on her, necessitating security guard intervention and administration of Haldol by injection. That was after several hours of attempted behavioural interventions, de-escalation techniques, and oral medications had already been tried.

 

[michaelrack]

The first few days of her initial admission to hospital she did have a couple of code blacks (imminent risk to self or others) called

Most use another color for that code . It would not be good to have patients or family hear about a "code black ". Your story must be from years ago

 

[Ceke2002]

Most use another color for that code . It would not be good to have patients or family hear about a "code black ". Your story must be from years ago

It was early 2019. I have the admission and discharge notes from the hospital, it definitely records it as a 'code black' being called, which is consistent with what family members present reported as well. Not sure if the code colour is specific to the hospital my Mum was initially admitted to, or if they just hadn't updated to a newer code system at the time. I was surprised at the code colour as well, because I always associated a code black with things like potential bomb threats, not a patient in need of security guards and Haldol.

Edited to add: Nope, okay, I just checked and according to SA Health the code for a security incident (imminent risk of harm to self or others) is Code Black in South Australia.

 

[michaelrack]

It was early 2019. I have the admission and discharge notes from the hospital, it definitely records it as a 'code black' being called, which is consistent with what family members present reported as well. Not sure if the code colour is specific to the hospital my Mum was initially admitted to, or if they just hadn't updated to a newer code system at the time. I was surprised at the code colour as well, because I always associated a code black with things like potential bomb threats, not a patient in need of security guards and Haldol.

Edited to add: Nope, okay, I just checked and according to SA Health the code for a security incident (imminent risk of harm to self or others) is Code Black in South Australia.

Did not realize your country. Having that code color called on a violent patient in the USA would cause problems

 

[Ceke2002]

Did not realize your country. Having that code color called on a violent patient in the USA would cause problems

Yes, I can imagine it would. Apparently the code colour for a bomb threat here is purple, apparently because a potential bomb needs a more sparkly sounding colour attached to it </sarcasm>.

Colour Codes and meanings for Australian hospitals:

Code black: personal threat
Code black alpha: missing or abducted infant or child
Code black beta: active shooter
Code black j: self-harm
Code blue: medical emergency
Code brown: external emergency (disaster, mass casualties etc.)
Code CBR: chemical, biological or radiological contamination
Code orange: evacuation
Code purple: bomb threat
Code red: fire
Code yellow: internal emergency
Code grey: combative person without a weapon

There's also Code Green Maternity in Victoria (immediate Caesarean for life threatening emergency), but I don't know if that one's standard on a national level.

 

[Liquid8]

The Codes are different in each Australian states – some use Code Grey for personal threats, reserving Code Black for less common armed threats.

Can remember discussing this a while back with a Canadian doctor who told me they used Code White for violence/behavioural systems.

 

[clausewitz2]

The Codes are different in each Australian states – some use Code Grey for personal threats, reserving Code Black for less common armed threats.

Can remember discussing this a while back with a Canadian doctor who told me they used Code White for violence/behavioural systems.

Our violent/combative person alert in outpatient/general medical settings in our system is Code Green. Usually it's an overhead page asking for Mary Greene to come to such and such a room

 

[Matthew9Thirtyfive]

Yes, I can imagine it would. Apparently the code colour for a bomb threat here is purple, apparently because a potential bomb needs a more sparkly sounding colour attached to it </sarcasm>.

Colour Codes and meanings for Australian hospitals:

Code black: personal threat
Code black alpha: missing or abducted infant or child
Code black beta: active shooter
Code black j: self-harm
Code blue: medical emergency
Code brown: external emergency (disaster, mass casualties etc.)
Code CBR: chemical, biological or radiological contamination
Code orange: evacuation
Code purple: bomb threat
Code red: fire
Code yellow: internal emergency
Code grey: combative person without a weapon

There's also Code Green Maternity in Victoria (immediate Caesarean for life threatening emergency), but I don't know if that one's standard on a national level.

What the hell? That’s so many different types of code black. Seems unnecessarily confusing.

 

[Ceke2002]

What the hell? That’s so many different types of code black. Seems unnecessarily confusing.

I believe in practice, at least in South Australia, they don't differentiate between different types of code blacks. Can't speak for Victoria (although I live here now) or other States. A code black automatically triggers a response from security guards and senior medical staff for South Australian security incident management in hospitals, I can see how security guards might appreciate a sub-code to let them know the exact nature of the incident they will be attending, but it also does seem a tad unwieldy to me too.

I'd have to double check my Mum's notes, but from memory I believe the first code black that was called was due to her physically threatening a family member visiting a patient on the ward, and the second one was for escalating self harm (at the time she was having episodes where she'd punch herself in the face, tear out her hair and bang her head into the wall). Neither of the code blacks were written up as having a separate code for 'threatening safety of others' or 'self harm'.

 

[Ceke2002]

The Codes are different in each Australian states – some use Code Grey for personal threats, reserving Code Black for less common armed threats.

Can remember discussing this a while back with a Canadian doctor who told me they used Code White for violence/behavioural systems.

I've just been having a look at the guidelines for a code black call in South Australia, and it does seem a tad convoluted. Looking at the guidelines for security response it seems to differentiate between a code black call being made and the outcome of the response to that call, including security on standby, security stood down, security not needed due to successful verbal de-escalation, etc, (I'm paraphrasing as well). Maybe I'm not looking at this properly, but to my mind why would you call a code black if you only needed security to standby, or the incident hadn't escalated to the point that verbal de-escalation was no longer an option.

 

[Stagg737]

Our violent/combative person alert in outpatient/general medical settings in our system is Code Green. Usually it's an overhead page asking for Mary Greene to come to such and such a room

For the VA code orange is behavioral code and at our academic center it's just "BRT" (behavioral response team). Pretty sure code black for us is a missing baby, or abduction, or something. I just know it's not relevant to psych at our hospital.