Haloperidol ... - page 2

by rninme 2,672 Views | 13 Comments

I had an acutely psychotic patient with an order for IV Haloperidol.... I went to the pyxis...selected haloperidol lactate...it dispensed the med. In reading the vial, it stated "FOR IM ADMINISTRATION ONLY". Great...I thought I... Read More

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    We have always giving it IM or IV. But then again I work in CCU with cardiac monitor. It's true that Haldol can prolong Q-T interval and could potentially lead to Torsades. I like ativan a lot better though.
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    Quote from barbyann
    I just put my lawyer cap on and it is all very clear. If the vial states IM only, then you would have a heck of a time convincing the jury you acted in good faith. I have been in many arguements over this drug/route difference of opinion. Stand your ground.
    Nurses use drugs in 'off-label' ways by order ALL THE TIME.

    The legal test isn't in the official FDA label but what a prudent nurse would do. Several sources cite that IV haldol lactate is an acceptable choice.

    A 'prudent' nurse can indeed use a drug in an 'off-label' fashion. We do it all the time.

    But, as has been pointed out, several facilities have policies AGAINST this practice and that policy would take priority in a legal case. If you disobey hospital policy, you probably WILL be liable in a legal suit. So, the first order of business if you are concerned about IV haldol is to check your hospital policy.

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    I work in an ICU and we use Haldol IV all the time. It's one of the more frequently ordered drug for severe agitation when ativan/versed, etc. are not effective. Usually the order will read 5mg Haldol IV Q 1 hour. The vials we use say "For IM use only". I've questioned this as well in my unit only to hear "it's always been given". I do monitor my patients for changes in the QT interval and have seen Haldol significantly prolong the QT interval.

    Melanie = )
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    The manufacturer is covering his butt by putting IM only on the vial. The hospital is covering their butt by making policies in regards to Haldol IV. And yet I still see nurses give Haldol IV "cause thats what the MD ordered" "the Pharmacist said it was OK". Protect yourself, always.

    I don't think off label use would be a consideration for this route override issue. Therapeutic effect/desired effect is the same just more timely IV. Risk vs. benefit, how much risk are you willing to take?