[Blackcat99]

The hospice doctor doesn't want us to use our judgement in regards to giving ativan. Some of the families have complained that our patients became too sedated from taking ativan. I was curious if other hospices have had this kind of problem? My patients seemed more comfortable and slept at night much better when they received both morphine and ativan together.

[suebird3]

That is due to the additive effect of the Ativan and Morphine. Are you checking the respirations?

Suebird

[Blackcat99]

Thanks Suebird. When I first started at hospice everyone was giving both meds together. I was told that the most important thing in hospice is to make sure your patient is comfortable and free of pain.

[earle58]

is this hospice doctor new? it's a standard of practice to administer an anxiolytic. pts fear pain. fear creates anxiety....i don't understand his rationale. of course you don't want the pt. snowed. it's all about balance between relief of pain & anxiety and remaining alert. maybe it's just a matter of a dose adjustment. if pts get anxious (because of them not receiving ativan et al) document your observations in the nurse's notes. this is scary.

leslie

[BeExcellent]

The part that gave me pause (or paws to you Blackcat) was you wrote this is a hospice doctor. So..what do they wish to use for anxiety, insomnia, restless?

[oreocookie]

I work in long-term care where some of the patients are hospice patients. They remain in the long-term care facility and the nurses from the hospice agency came to visit daily. The hospice nurse that was caring for one of my patients suggested giving morphine and ativan together prn with no concern.

[nckdl]

I know at our ltc when a pt is hospice we try to give morphine first and if that doesn't work after an hour we give ativan. Also we are told that the ativan also helps with nausea instead of having to give phenergan Im on top of it all.

[Just wondering]

I had this client who was on hospice, had zero po intake for a week prior to passing. About a few days before she died she was scheduled on 0.5mg ativan SL EVERY 4 hours(dilute in 5cc H20), & Roxanol 0.5mL (10mg) po PRN Q 2 hours for distress.


I had a dilemma one night pt RR was about 44-46/min. I gave the first dose of Roxanol and gave the 2nd 2 hours later for distress and held the next scheduled ativan. I held the ativan b/c I have no experience seeing this effect, and my pt's RR decreased to the low 30's. It made her comfortable with no distress. Does the above dose sound too much for a person on comfort measures???

Just me

[earle58]

Originally Posted by Just wondering

I had this client who was on hospice, had zero po intake for a week prior to passing. About a few days before she died she was scheduled on 0.5mg ativan SL EVERY 4 hours(dilute in 5cc H20), & Roxanol 0.5mL (10mg) po PRN Q 2 hours for distress.


I had a dilemma one night pt RR was about 44-46/min. I gave the first dose of Roxanol and gave the 2nd 2 hours later for distress and held the next scheduled ativan. I held the ativan b/c I have no experience seeing this effect, and my pt's RR decreased to the low 30's. It made her comfortable with no distress. Does the above dose sound too much for about person on comfort measures???

Just me

what are you questioning: the ativan or the roxanol? both doses are wnl but can't answer its' appropriateness unless i know the pt. .5mg q4h is on the low side-i'm accustomed to giving more.
what i aim for in lowering rr's, is to give the mso4 until respirations are down to teens, or as close to that as possible.
you would probably have an mi if you knew the doses we give.
just to keep in mind, dosages should reflect the pt's acuity.
much luck to you.

leslie

[Blackcat99]

Thanks all for your insights. Our hospice doctor is not new. I think he was just concerned because a few of our patients seemed "over-medicated" according to their families. A few of them did seem to be a little "snowed" when they were given ativan. The doctor is now writing orders for ativan 0.5mg every 4 hours on certain patients. So we are using ativan again just in smaller doses than before.