Treatment Options for Combative Patient

You are the doctor on call when you are called to the ward to see an elderly, confused man. He is wandering around and crying out. The nurses have tried persuading him to stay by his bed or at least in his bay, but he is refusing to listen to them. One female patient has become upset because he keeps going to stand at the end of her bed and stares at her. The nurses are worried that as well as upsetting other patients, he is very unsteady on his feet and they fear he may fall over and injure himself. You read his notes to try to find a cause for his confusion. You learn that Micky, 76 years old, was an elective admission yesterday for a laparoscopic cholecystectomy. Two weeks earlier he had been admitted to Accident and Emergency with shortness of breath and pleuritic chest pain. He was kept in for 3 days and treated with intravenous antibiotics. There are at least two possible causes for his confusion: a recurrence of his pneumonia (or other sepsis) or a reaction to the general anesthetic. You decide to speak to him and try to take some blood. He refuses to cooperate and actively pushes you away from him, shouting and swearing. He then tries to leave the ward, claiming he is well enough to go home and it is illegal for you to keep him a prisoner.

• Should he be physically restrained so that you can take blood and assess him?
• Is it a good idea to give him a sedative so that he does not continue to upset the other patients?
• What are your options in this case and how/why would you implement each of them?

Apply Theory (Specific Professional Healthcare Competencies + Clinical Medical Ethical Principles) to Practice in order to provide Optimal Patient-Centered Care (OPCC)

Clinical Ethics and Law, Second edition. Carolyn Johnston, Penelope Bradbury, Series editor: Janice Ryme