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In the ED where I work, our accepted but unwritten practice is to wait for 4 hours to release a patient after she's been given a sedating drug if she isn't accompanied by another competent adult. Her potential altered level of consciousness would put her at risk for injury, especially if she's driving home. We use this waiting period after administering drugs such as opioid analgesics, diphenhydramine (Benadryl), and promethazine (Phenergan).


Recently, a patient who'd driven to the ED alone received an opioid analgesic. Her physician insisted she be released without waiting the customary 4 hours. The nurses believed that this put her in danger and exposed the hospital and nursing staff to liability.


We took our problem to the ED nurse-administrator, but she said that without a written policy in place or some written evidence to back our position, she couldn't do anything. Even without a written policy, shouldn't the hospital have kept the patient from leaving by herself?-C.V., N.H.


Yes. Just because a facility doesn't have a policy or procedure addressing a specific practice doesn't mean there isn't a generally recognized standard of care. This standard is established many ways, including in the professional literature and recognized standards.

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It's very likely that other facilities would prevent the patient from leaving alone until doing so is safe, and the ED nurses seem to recognize that. The crucial test boils down to this: "What would a reasonably prudent nurse do in a similar circumstance?"


Making sure that a patient who's received a potentially sedating drug doesn't leave alone or drive until it's safe shows sound nursing judgment. If the patient were released prematurely and caused an accident, she or anyone else who was harmed could bring a negligence action.


When you don't agree with a physician's order, follow the chain of command. To address this issue, your facility should form a multidisciplinary committee to develop a formal policy and procedure. Members of the committee should include ED staff nurses, physicians, and representatives from administration, risk management, and pharmacy.