Chemical restraint and lazy nurses

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MrChicagoRN, RN

2,597 Posts

Specializes in Leadership, Psych, HomeCare, Amb. Care.
I didn't know that about clonazepam. Thank you for the info. He gets a few other meds. Geodon 20mg. Metformin 500. Melatonin 5mg OTC. And a few others I can't quite remember at this time. The NP told me that the geodon could be making him sleepy and she would see about changing it.

It's not the geodon. Like I had mentioned before, the one day he didn't get the clonazepam, he was awake and alert the next AM. But no one listens to me.....

Why Geodon? Doesn't sound appropriate.

"Ziprasidone is not approved by the Food and Drug Administration (FDA) for the treatment of behavior problems in older adults with dementia. Talk to the doctor who prescribed this medication if you, a family member, or someone you care for has dementia and is taking ziprasidone. For more information visit the FDA website: http://www.fda.gov/Drugs "

http://www.nlm.nih.gov/medlineplus/druginfo/meds/a699062.html

Veronica.c

47 Posts

Why Geodon? Doesn't sound appropriate. "Ziprasidone is not approved by the Food and Drug Administration (FDA) for the treatment of behavior problems in older adults with dementia. Talk to the doctor who prescribed this medication if you a family member, or someone you care for has dementia and is taking ziprasidone. For more information visit the FDA website: http://www.fda.gov/Drugs " http://www.nlm.nih.gov/medlineplus/druginfo/meds/a699062.html

There are many patients in the facility on geodon. Many!!! I was taught in school how dangerous this drug was and wondered the same thing myself.

It has a black box warning but it's given very often....

Veronica.c

47 Posts

But that's so much more fun than acknowledging that they may actually be competent and doing the best they can to deal with sundowning with the resources they have.

For your information!.... The "nurses" involved that pushed to have the bed reinstated were on Facebook posting pics of themselves goofing off at work that particular night that they called the np and had it reinstated!

Doesn't seen to me like they're doing the best the can! Seems to me like they are exactly what I said they are plus many other things. Incompetent, lazy and certainly NOT a patient advocate.

Thank u

Veronica.c

47 Posts

Why "should" he be up and alert everyday at 8am? He's an old man with alzheimers. I doubt very much that half a mg of klonopin is knocking him out from bedtime to 12pm the next day. Obviously he is awake much of the night. Is it really that surprising he sleeps in? The medication was ordered PRN for agitation. A demented resident trying to get out of bed and falling at 2am counts as agitation. What else was it ordered for?[/quote']

It's not PRN. Read the post. .

Veronica.c

47 Posts

Because meds like Clonazepam and Ativan do have high risks for over sedation falls, etc and use is scrutinized heavily by state surveyors, it is to your facilities benefit to cut back on their use at times and monitor their use closely. Documentation needs to be stellar to show that they are in place to benefit the Resident and keep him and others from harm, that other interventions have been tried and they are not being used as a restraint for staff convenience. Periodically pharmacists will request reviews of these meds and suggest cutting such meds back. Physicians have to review those requests and document why they chose to disregard them. In fact, our facility has a committee that's sole purpose is to review psychotropic med usage and documentation, and these meds also come up for scrutiny in team and when care planning. Residents on psychotropic meds are often followed by psych as well in addition to their general practitioner. As a PRN nurse, you may not be aware indeed how often this particular subject is addressed for this gentleman as you are not part of his regular caregivers. Also, one time of alertness in the am when not given his PM dose, while worthy of being noted, is not proof of anything, unfortunately. What I would do is note that, pass it on in report to the next shift and my supervisor and document that as well. Further more I would document thereafter every day I took care of this man when I noted excessive sleepiness and be very precise as to his level of consciousness. When I had several weeks worth of documentation to support me, I'd request a psych eval or follow up. I'd also talk with the other shifts to get their opinion on d/c'ing the medication. My course of action would be to try get the MD/or Psych doc to change the HS dose from scheduled to PRN. Then, when it is given, staff have to show cause and what non pharmaceutical measures they took in order to justify it. When the surveyors come in and determine the over sedation has not been addressed or documentation does not support giving the med, the facility is likely to be cited and the med will likely be d/c'd. I also have to suggest that even if you're certain you're right, be humble and ask others what they think. Whenever I want to make a change for a Resident whether it's a med administration time or scheduling pain meds that will affect another shift I try to to get their input. Don't rush to judgement and assume either that they are lazy or incompetent either when they don't agree with you. Be methodical, courteous and try to go through proper channels as much as possible. Document, document, document! If you want to be taken seriously, don't resort to drama or crying - even if you feel like it. Be patient, it takes time sometimes for changes to hapoen. Best of luck to you![/quote']

Thank you for informed and well advised opinion and advice. You are right about the drama. I never have meltdowns but did this one time and I wish I wouldn't have gotten so involved. I just care so much about my people. Maybe I shouldn't idk.

Your facility sounds like it really has it together. Unfortunately there is no committee at mine...it's very small and a lot of what you say should happen, doesn't at this place. I wish it did!

Also, thank you for telling me not to be so harsh when judging my coworkers. You're right, maybe I should listen to them more. These particular nurses really upset me though. The night that they had te Klonopin reinstated, they were actually at work, posting pictures of themselves playing around on the job. On the job! All I could think was...who is taking care of the patients while you two are outside playing??? They certainly aren't monitoring this man or the others who are a fall risk. So knocking them out with meds is easy for them when they are busy playing.

Veronica.c

47 Posts

We had a pt who was on Ativan qid and PRN and had been for several years we sent her to the hospital because of change in condition, and altered mental status and they sent her back with a diagnosis of over sedation from Ativan, discontinued it and wrote a fairly hostile note. When I asked another nurse why the pt was on ativan it was because they had tried to kill their roommate. The dose had not changed for quite some time. There were lots of other details that I won't get into but until everyone knows the whole story there might be a reason for the psyc med. What is the diagnosis for psyc med? Is there any history of violence? You sound like a good advocate for your patients, but also seem a little closed minded to your opinion only. One day shift of alertness might not be enough to give you a full picture of what is really going on.[/quote']

Thank you. You're right when you say I am close minded. I need to work On that

No violence history.

MunoRN, RN

8,058 Posts

Specializes in Critical Care.
Why Geodon? Doesn't sound appropriate.

"Ziprasidone is not approved by the Food and Drug Administration (FDA) for the treatment of behavior problems in older adults with dementia. Talk to the doctor who prescribed this medication if you, a family member, or someone you care for has dementia and is taking ziprasidone. For more information visit the FDA website: Drugs "

Ziprasidone: MedlinePlus Drug Information

All antipsychotics have been shown to increase mortality in dementia patients, yet they are still used in dementia patients and for good reason.

Haldol isn't used much anymore because it's risk is significantly higher than atypical antipsychotics, but seroquel, abilify, risperdal, olanzapine, and geodon are all still frequently used, despite the fact that they double mortality risk compared to placebo.

Despite the risks there's been no major push to just stop using these medications in dementia patients because it may be worth the risk. Dementia can be a brutal disease, leaving patients with a persistent feeling of fear, distress, agitation, anger, etc, which often deserves treatment despite an increased risk. You can squeeze a bit more life out of someone with dementia by not using these medications, but if they are miserable is there really any benefit to giving them more time to be miserable?

Veronica.c

47 Posts

I think that since you work PRN and you do not have to deal with this pt on a daily basis you should really reserve judgment and not call your coworkers lazy. I would look into whether or not this over-sedation is new or not, since you just noticed it yourself. If so, maybe his kidney function needs to be looked at.[/quote']

You're right. I should have looked at other avenues as to why he was lethargic. That could be the case many times.

As at as my prn status, yes technically prn BUT work enough to have overtime often so I am there a lot. Jut not day shift.

As far as the other nurses, I pointed out to a few other posters something I probably should have elaborated on in the original post. The offending shift truly does neglect. I work elbow to elbow with these ladies. Some are good. Some like hour long lunch break and falsifying bps and blood sugars. Some like posting pics of themselves playing outside while on the clock and there is no nurse in the facility. These are the nurses I am judging. It's not a far stretch to assume...better yet...know! That yes, they are lazy.

Veronica.c

47 Posts

Perhaps it's time to report this to the state obundsman or the state. Another option is to involve the family. Make your suggestions to the family. Usually the family is listened to. Regarding the falls: sounds like the patient needs a bed on the floor and a Geri psych eval to ensure proper med dosing. It certainly sounds like he is being chemically restrained and has poor quality of life (hence my state obundsman contact suggestion). Good luck

If I reported to family they would fire me... I see his family and want so bad to say something. But I need my job more.

Veronica.c

47 Posts

I would wonder if he is put to bed for goodness sake at 3PM, and left till noon the next day--why is that allowed??!!! I am pretty sure that someone without dementia would get restless and nuts being EXPECTED to remain in bed for that many hours, let alone, someone with dementia!!!!! Maybe if he is engaged in some type of activity he might be entertained, tired and woud sleep better without over-sedation. AS an MDS coord, I would hope this is addressed in is care plan, and that regular meetings are being held. It is, as a PP poster stated, a federal regulation[/quote']

I agree. With everything you say. That would be an ideal circumstance for this pt.

No meetings happen though...it just looks like they are

BrandonLPN, LPN

3,358 Posts

It's not PRN. Read the post. Jesus.

OK, so its scheduled. It still seems like it was ordered because his sundowning was causing him to be agitated and a huge fall risk.

And you're jumping to conclusions if you think just because this guy is sleeps till noon, that means the night nurse doped him 'cause she's lazy. You owe your nursing co-workers the professional courtesy of NOT making such assumptions.

Really, you seem very quick to judge your nursing coworkers. You imply they are lazy because they give a doctor ordered sedative to counter his sundowning. What would you have them do? Short of a 1:1 which, as you must know, is almost never in the budget.

You say your facility does not have meetings and is very poor at care-planning. OK..... join the club. This does not mean your nursing coworkers are lazy, "criminals" or anything else of the sort.

I'm sorry, but it really seems to me that you're making this all about you, and how you want to be painted as the tragic martyr or the heroic whistle-blower or something.

Your co-workers are doing the best they can with what they have. Sure, it would be great if we could provide our demented residents with the 24/7 one-on-one care they need to keep them safe. You know and I know that's not possible. When you have one nurse and two aides responsible for 40 demented residents some of them are going to get sedatives as part of their medication regimen.

dudette10, MSN, RN

3,530 Posts

Specializes in Med/Surg, Academics.

I'm sorry, but it really seems to me that you're making this all about you, and how you want to be painted as the tragic martyr or the heroic whistle-blower or something.

That's the feeling I get too. My second post was much abbreviated--and rewritten several times--because the assumption by the OP that medication timing was "irrelevant," and I just sorta threw up my hands at trying to help.

If you work there enough, even overtime, DO something! There have been a LOT of good suggestions here for helping this man, but you insist upon helplessness. Don't.

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