Difference between revisions of "Harbor:Involuntary holds"

Line 3: Line 3:
  
 
==Psychiatric reason==
 
==Psychiatric reason==
**5150 (5585 for Peds) only for a '''mental health disorder.'''  
+
*5150 (5585 for Peds) only for a '''mental health disorder.'''  
**Voluntary patients usually not placed on a 5150/5585, but can be.  
+
*Voluntary patients usually not placed on a 5150/5585, but can be.  
**Non-psychiatric medical personnel can detain anyone who meets criteria until they can be evaluated by a psychiatrist.
+
*Non-psychiatric medical personnel can detain anyone who meets criteria until they can be evaluated by a psychiatrist.
**'''5150 can be placed by''':
+
*'''5150 can be placed by''':
*** '''Psychiatrist ONLY INSIDE''' MAIN HOSPITAL BUILDING
+
** '''Psychiatrist ONLY INSIDE''' MAIN HOSPITAL BUILDING
*** '''Sheriff ANYWHERE OUTSIDE''' MAIN HOSPITAL BUILDING, including rest of hospital grounds
+
** '''Sheriff ANYWHERE OUTSIDE''' MAIN HOSPITAL BUILDING, including rest of hospital grounds
****Sheriff has independent authority to place the 5150 or not
+
***Sheriff has independent authority to place the 5150 or not
  
 
==Medical reason==
 
==Medical reason==
**Patients who '''lack capacity''' and are a danger to themselves or others for non-psychiatric reasons. Do not need psych consult to determine capacity when restraining patient for a medical reasons, and psych cannot override decision to restrain a patient for non-psychiatric reasons. DO NOT REFER TO THIS AS A "HOLD" AS THIS MAY LEAD LAW ENFORCEMENT TO BELIEVE THE PATIENT IS ON A 5150.  
+
*Patients who '''lack capacity''' and are a danger to themselves or others for non-psychiatric reasons. Do not need psych consult to determine capacity when restraining patient for a medical reasons, and psych cannot override decision to restrain a patient for non-psychiatric reasons. DO NOT REFER TO THIS AS A "HOLD" AS THIS MAY LEAD LAW ENFORCEMENT TO BELIEVE THE PATIENT IS ON A 5150.  
**If they try to elope you can detain/restrain, if they become violent or aggressive, call a CODE GOLD (see below).  
+
*If they try to elope you can detain/restrain, if they become violent or aggressive, call a CODE GOLD (see below).  
**These patients can be held against their will for their own safety no 5150 is required or applies (5150 for psych issues only).
+
*These patients can be held against their will for their own safety no 5150 is required or applies (5150 for psych issues only).
** No specific legal form for restraining medical patients - document reasons in chart. Use '''restraint form''' for restraints.  
+
* No specific legal form for restraining medical patients - document reasons in chart. Use '''restraint form''' for restraints.  
  
 
==Code GOLD==
 
==Code GOLD==
**For all patients who become physically aggressive, either for psychiatric or medical reasons.
+
*For all patients who become physically aggressive, either for psychiatric or medical reasons.
**They will be placed in '''hard restraints''' by CODE GOLD team
+
*They will be placed in '''hard restraints''' by CODE GOLD team
**Call x111.  
+
*Call x111.  
**'''No requirement''' patient be placed or already on 5150
+
*'''No requirement''' patient be placed or already on 5150
**LASD (Sheriff) responds but is not part of team, only assists if detect or to prevent criminal activity by patient (assault)
+
*LASD (Sheriff) responds but is not part of team, only assists if detect or to prevent criminal activity by patient (assault)
**Behavioral Response Team leader (BRT) should ID themselves on arrival and ED physician or nurse in charge of patient should brief them.   
+
*Behavioral Response Team leader (BRT) should ID themselves on arrival and ED physician or nurse in charge of patient should brief them.   
**BRT leader has option of turning over situation to LASD as needed.
+
*BRT leader has option of turning over situation to LASD as needed.
  
 
==Code GREEN==
 
==Code GREEN==
**'''Already on or eligible for a 5150/5585''' and attempting to, or have physically left the department.  
+
*'''Already on or eligible for a 5150/5585''' and attempting to, or have physically left the department.  
**Call x3311 LASD(Sheriff)
+
*Call x3311 LASD(Sheriff)
**'''On a 5150 hold''' - LASD will return patient
+
*'''On a 5150 hold''' - LASD will return patient
**'''NOT on 5150 hold'''
+
*'''NOT on 5150 hold'''
***'''Inside''' Hospital Building - LASD can only convince patient to return - can't forcibly return. '''Only Psych''' can place 5150 inside hospital building
+
**'''Inside''' Hospital Building - LASD can only convince patient to return - can't forcibly return. '''Only Psych''' can place 5150 inside hospital building
***'''Outside''' Hospital Building - LASD makes independent determination to place patient on 5150
+
**'''Outside''' Hospital Building - LASD makes independent determination to place patient on 5150
****Physician or nurse in charge of patient should brief LASD if patient on 5150 or if not, indication for 5150
+
***Physician or nurse in charge of patient should brief LASD if patient on 5150 or if not, indication for 5150
**If LASD decides not to place patient on 5150, document Code Green in chart and officers involved
+
*If LASD decides not to place patient on 5150, document Code Green in chart and officers involved
  
 
==Code GRAY==
 
==Code GRAY==
**'''ANYONE''' (patient, visitor, staff) who is combative or assaultive and it is not felt due to a medical or psychiatric reason
+
*'''ANYONE''' (patient, visitor, staff) who is combative or assaultive and it is not felt due to a medical or psychiatric reason
  
 
*'''Above vetted by Law Enforcement, Psychiatry, Behavioral Response Team, ED Leadership, and Nursing leadership'''
 
*'''Above vetted by Law Enforcement, Psychiatry, Behavioral Response Team, ED Leadership, and Nursing leadership'''
*Additional References
+
 
**436 Procedures in Cases To Be Reported to Are Investigated by Law Enforcement Authorities
+
==Additional References==
**301 Discharge Policy, Procedures, and Guidelines Including Elopement and AMA
+
*436 Procedures in Cases To Be Reported to Are Investigated by Law Enforcement Authorities
**138 Law Enforcement Use of Force on Harbor-UCLA Campus
+
*301 Discharge Policy, Procedures, and Guidelines Including Elopement and AMA
**347A The Use of Restraints Including Seclusion
+
*138 Law Enforcement Use of Force on Harbor-UCLA Campus
**346 Involuntary Holds on and on Psychiatric Units and Emergency Medical Department
+
*347A The Use of Restraints Including Seclusion
**379 Safety Attendant (Continuous in Person Monitoring)
+
*346 Involuntary Holds on and on Psychiatric Units and Emergency Medical Department
**453 Patients in Police Custody
+
*379 Safety Attendant (Continuous in Person Monitoring)
**347B Code Gold-Behavioral Response Team
+
*453 Patients in Police Custody
**620 Consent for Medical Treatment for Patient Lacking the Capacity to Provide Consent
+
*347B Code Gold-Behavioral Response Team
**Sheriff "Cheat Sheet" for Code Green and Code Gold
+
*620 Consent for Medical Treatment for Patient Lacking the Capacity to Provide Consent
 +
*Sheriff "Cheat Sheet" for Code Green and Code Gold
  
 
==Public Health==
 
==Public Health==

Revision as of 23:05, 7 January 2019

Overview

INVOLUNTARY HOLDS: CODE GOLD, & COLD GREEN

Psychiatric reason

  • 5150 (5585 for Peds) only for a mental health disorder.
  • Voluntary patients usually not placed on a 5150/5585, but can be.
  • Non-psychiatric medical personnel can detain anyone who meets criteria until they can be evaluated by a psychiatrist.
  • 5150 can be placed by:
    • Psychiatrist ONLY INSIDE MAIN HOSPITAL BUILDING
    • Sheriff ANYWHERE OUTSIDE MAIN HOSPITAL BUILDING, including rest of hospital grounds
      • Sheriff has independent authority to place the 5150 or not

Medical reason

  • Patients who lack capacity and are a danger to themselves or others for non-psychiatric reasons. Do not need psych consult to determine capacity when restraining patient for a medical reasons, and psych cannot override decision to restrain a patient for non-psychiatric reasons. DO NOT REFER TO THIS AS A "HOLD" AS THIS MAY LEAD LAW ENFORCEMENT TO BELIEVE THE PATIENT IS ON A 5150.
  • If they try to elope you can detain/restrain, if they become violent or aggressive, call a CODE GOLD (see below).
  • These patients can be held against their will for their own safety no 5150 is required or applies (5150 for psych issues only).
  • No specific legal form for restraining medical patients - document reasons in chart. Use restraint form for restraints.

Code GOLD

  • For all patients who become physically aggressive, either for psychiatric or medical reasons.
  • They will be placed in hard restraints by CODE GOLD team
  • Call x111.
  • No requirement patient be placed or already on 5150
  • LASD (Sheriff) responds but is not part of team, only assists if detect or to prevent criminal activity by patient (assault)
  • Behavioral Response Team leader (BRT) should ID themselves on arrival and ED physician or nurse in charge of patient should brief them.
  • BRT leader has option of turning over situation to LASD as needed.

Code GREEN

  • Already on or eligible for a 5150/5585 and attempting to, or have physically left the department.
  • Call x3311 LASD(Sheriff)
  • On a 5150 hold - LASD will return patient
  • NOT on 5150 hold
    • Inside Hospital Building - LASD can only convince patient to return - can't forcibly return. Only Psych can place 5150 inside hospital building
    • Outside Hospital Building - LASD makes independent determination to place patient on 5150
      • Physician or nurse in charge of patient should brief LASD if patient on 5150 or if not, indication for 5150
  • If LASD decides not to place patient on 5150, document Code Green in chart and officers involved

Code GRAY

  • ANYONE (patient, visitor, staff) who is combative or assaultive and it is not felt due to a medical or psychiatric reason
  • Above vetted by Law Enforcement, Psychiatry, Behavioral Response Team, ED Leadership, and Nursing leadership

Additional References

  • 436 Procedures in Cases To Be Reported to Are Investigated by Law Enforcement Authorities
  • 301 Discharge Policy, Procedures, and Guidelines Including Elopement and AMA
  • 138 Law Enforcement Use of Force on Harbor-UCLA Campus
  • 347A The Use of Restraints Including Seclusion
  • 346 Involuntary Holds on and on Psychiatric Units and Emergency Medical Department
  • 379 Safety Attendant (Continuous in Person Monitoring)
  • 453 Patients in Police Custody
  • 347B Code Gold-Behavioral Response Team
  • 620 Consent for Medical Treatment for Patient Lacking the Capacity to Provide Consent
  • Sheriff "Cheat Sheet" for Code Green and Code Gold

Public Health

    • (213) 745-0800 (Tb)
    • 213-974-1234 after hours

Dir OPS 10/15/18 Dir AED, 10/28/16


See Also

References