Need info on PRN Haldol in LTC

[curiousauntie]

After 24 years in LTC, I know a lot about the federal regs, medication use etc. I am now working in hospice and most of the nurses that I work with have never done LTC nursing in any type of facility. I want to educate them on WHY LTC does not use Haldol, and especially PRN Haldol. We use haldol in our comfort kits, oral and compounded in a suppository along with Ativan, Compazine for intractable nausea/vomiting. Haldol is the drug of choice for end-of-life agitation, but since the regs call for documentation, copious charting and a diagnosis to support the use of an antipsychotic, most LTC that I have worked in do not allow hospice nurses to get orders for the PRN use of Haldol. Not even in the comfort kit for use when the awful symptoms of actively dying patients need interventions. Now the shoe is on the other foot, so to speak, as I was once the nurse telling the hospice case managers that I could not accept an order for PRN haldol, and now I am the nurse asking for the order! I get really frustrated trying to make the hospice nurses understand that the long term care nurses are not uncaring, but have very strict guidelines to go by for the use of certain medications. (most of the hospice nurses I work with are hospital nurses, where they use haldol prn frequently). What I need is to find where the regs are and the rational for NOT accepting that order for PRN haldol. Not policy for each facility, but the federal regs that support that policy. I did some searches on cms.gov, and medicare.gov, hoping to be able to find the actual F tags that support LTCs decision to not accept PRN haldol but could not find what I wanted. Any help would be nice, even if it just points me in the right direction.

Thanks.

[SuesquatchRN, BSN, RN]

Can't help. We use Haldol PRN for exit-seeking behaviors and certain other situations that can escalate to violence and can not be controlled by standard interventions.

[Calgon-take.me.away]

+From my experience with Haldol, it just makes them crazy. Alot of geriatric patients have an allergy or an adverse reaction to Haldol. Also, we have strict charting guidlines that we have to follow on what, when and for the reason we use a chemical restraint. Actually,,,you have better choices, ie Ativan or Klonopin for those extreme cases

[CapeCodMermaid, RN]

Sorry I can't quote you chapter and verse on the regs, but: I know you can't have a PRN antipsychotic order on its own. For instance if someone gets Seroquel 50 mg twice a day, you can have an order for a PRN dose for increased agitation.

We used the ABHR suppositories for our end of life patients with terminal agitation...ativan,benadryl,haldol, reglan...also comes in a gel form. I've seen it work wonderfully well and we never had a problem with surveyors because it was well documented that it was being used for terminal agitation at the end of life. Haldol, as you probably know, is considered a chemical restraint and has a multitude of side effects,especially in the elderly population.

Good luck with your search for the regs. Could you call your state's DPH and ask them to tell you what the regs are?