No ativan for hospice patients

[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.

[uahrn915]

Many elderly pts are knocked for a loop by pain meds/anxiety meds, but if they are truly appropriate hospice pts, you don't want to see them with RR >30. Use that PRN med and have the standing order to increase dose by 50% PRN when you really need it. Our hospice pts have responded extremely well to compounded medications to help with pain & anxiety. Ativan/Benedryl/Haldol (ABH gel) works fantastic and is absorbed thru the skin over the carotid. mso4 can also be compounded and applied this way.

[RN4ustat, BSN, RN]

I recently attended a teleconference regarding terminal restlessness/agitation and was a little surprised to learn that often times, ativan is to blame for increased restlessness/agitation. The physicians that were giving this seminar recommended haldol or even risperdal which doesn't cause as much euphoria. I'll have to find the documentation from that seminar and post the specifics. It was VERY interesting actually!!

[leslie :-D]

RN4ustat said:

I recently attended a teleconference regarding terminal restlessness/agitation and was a little surprised to learn that often times, ativan is to blame for increased restlessness/agitation. The physicians that were giving this seminar recommended haldol or even risperdal which doesn't cause as much euphoria. I'll have to find the documentation from that seminar and post the specifics. It was VERY interesting actually!!

esp among the elderly, ativan is known for its paradoxical agitation.

but i've seen it in risperdal, also.

leslie

[dosamigos76, RN]

uahrn915 said:

Ativan/Benedryl/Haldol (ABH gel) works fantastic and is absorbed thru the skin over the carotid. mso4 can also be compounded and applied this way.

I had never heard of applying it over the carotid, only rubbed into the palmar aspect of the wrist for approximately one minute. I goggled it and couldn't find any information on it. Interesting...

Cheryl

[JSCOOBY]

We use either Phenergan or Haldol.

[sharlynn]

dosamigos76 said:

I had never heard of applying it over the carotid, only rubbed into the palmar aspect of the wrist for approximately one minute. I goggled it and couldn't find any information on it. Interesting...

Cheryl

We use ABHR gel ( with Reglan) applied in a pulse area such as wrist and covered with Opsite.