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• Ask specifically about psychiatric medications.
Patients may be afraid if they admit taking medica-
tions used for treatment of behavioral disorders or apsychiatric history that they will be looked down on by CLINICAL TIPS
staff, says Freda Lyon, RN, BSN, MHA, service line
administrator at Bixler Emergency Center in Tallahassee.
“Patients are often embarrassed,” she says. “The emer-
gency nurse has to be perceived as nonjudgmental.”
Double-check whether
When asking questions about mental health history and medication history, be sure to explain the impor- patient is taking Viagra
tance of mediation interactions, says Lyon. “Ask thepatient if they have a list of the medications they areon from their last physician or hospital visit,” she sug- If your heart attack patient is taking erectile dys- function medication and doesn’t tell you, it could gests. “When all else fails, look at the patient’s visit list.” (See story on patients taking erectile dysfunc-
“The room is full of people, and questions are tion medications, left.)
being fired left and right. At times, the emphasis on • Ask open-ended questions.
Viagra is not as strong as it should be,” says Ina
Prado recommends asking things such as, “How can Helton, RN, unit expert for the ED at UAB Hospi-
“Encourage the patients to tell their own story in If the patient has taken Viagra and is given nitro- their own words and talk about whatever is important glycerin to treat chest pain, his blood pressure can drop very low, and this even can cause cardiac • Refer to the patient’s previous medical records.
“If these are available, this can be an invaluable tool,” Many men are ashamed to admit they take the says Morrow. Say, “I see you were taking _______ last medication, and they might deny it if asked directly, time you were here. Are you still on that?” she says. For that reason, you have to be very clear • Remind the patient that their responses and
with the patient about the life-threatening conse- their entire medical record are protected under
quences that could result from mixing nitrates and federal patient privacy law.
erectile dysfunction medication, Helton says. “In • Talk to the patient privately.
our ED, part of our chest pain assessment includes Ina Helton, RN, unit expert for the ED at UAB
asking if the patient has taken Viagra in the last 24 Hospital in Birmingham, AL, says, “At any time, you hours,” she says. “There have been a few patients can ask a visitor or a family member to step out of the who presented with chest pain with the onset during room.” (For more information on assessment of sub-
sex. For these times, questioning about taking Via- stance abuse, see “How to get an honest answer on
gra is a little easier because they have already cocaine use,” ED Nursing, August 2008, p. 116.) ■
“Ultimately, we are only as good as the information Could a child in need of
given to us by patients, pre-hospital caregivers, or fam-
ily members,” says J. Miller Morrow, RN, BSN, CEN,
help walk out of your ED?
ED nurse at St. Luke’s Baptist Hospital in San Antonio.
Watch for these signs that a patient isn’t being Don’t let child ‘seize the opportunity to elope’ truthful, says Imelda Prado, RN, clinical care coordi-
nator for the ED at Swedish Covenant Hospital in
Chicago: He or she is unable to look at you, gives
Achild who was involuntarily committed managed to walk out of the ED at All Children’s Hospital varying stories, friends and family give you conflict- in St. Petersburg, FL, right past a security guard and ing information, or the patient doesn’t give you clear details of the illness or complaints. Other warning “All this could have been prevented if the patient signs include lack of direct eye contact or looking had their clothing removed and a sitter or assigned over to family members or friends before answering staff was with the patient,” says Scott Phillips, RN,
questions posed to them, says Morrow. Try these Luckily, the patient was retrieved by a staff member

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