Parkinsons and Haldol - page 2

Hi all, a elderly PD patient goes to ER for a trip and fall on a wednesday everything is fine, thursday 1 hour hip surgery went great, gets demerol in the PACU, becomes confused, late thursday, friday and saturday gets a IV push... Read More

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    I also mentioned the drug alert system check this out.............

    Drug safety alert generation and overriding in a large Dutch university medical centre.
    van der Sijs H, Mulder A, van Gelder T, Aarts J, Berg M, Vulto A.

    Department of Hospital Pharmacy, Erasmus University Medical Centre, Rotterdam, the Netherlands. i.vandersijs@erasmusmc.nl
    Abstract
    PURPOSE: To evaluate numbers and types of drug safety alerts generated and overridden in a large Dutch university medical centre.

    METHODS: A disguised observation study lasting 25 days on two internal medicine wards evaluating alert generation and handling of alerts. A retrospective analysis was also performed of all drug safety alerts overridden in the hospital using pharmacy log files over 24 months.

    RESULTS: In the disguised observation study 34% of the orders generated a drug safety alert of which 91% were overridden. The majority of alerts generated (56%) concerned drug-drug interactions (DDIs) and these were overridden more often (98%) than overdoses (89%) or duplicate orders (80%). All drug safety alerts concerning admission medicines were overridden.Retrospective analysis of pharmacy log files for all wards revealed one override per five prescriptions. Of all overrides, DDIs accounted for 59%, overdoses 24% and duplicate orders 17%. DDI alerts of medium-level seriousness were overridden more often (55%) than low-level (22%) or high-level DDIs (19%). In 36% of DDI overrides, it would have been possible to monitor effects by measuring serum levels. The top 20 of overridden DDIs accounted for 76% of all DDI overrides.

    CONCLUSIONS: Drug safety alerts were generated in one third of orders and were frequently overridden. Duplicate order alerts more often resulted in order cancellation (20%) than did alerts for overdose (11%) or DDIs (2%). DDIs were most frequently overridden. Only a small number of DDIs caused these overrides. Studies on improvement of alert handling should focus on these frequently-overridden DDIs.

    2009 John Wiley & Sons, Ltd.

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  2. 1
    Quote from pd advocate
    that is so true and did you also know that patients who do not have pd, develop pd symptoms when taking haldol.
    a nurse told me haldol will make a insane person sane and a sane person insane

    that is called tartive dyskinesia and in rare instances become permanent. you seem to have a lot of information about this patient, his family, and his care.

    many drugs have serious side effects that can lead to death. all professionals involved are responsible to check and recheck to prevent these type of unfortunate events. haldol is contraindicated in other disease entities. not all states require informed consent for restraint or drug administration. the md should be aware of what they are ordering. the pharmacist should also be aware of the pt's disease process before filling the order and the nurse is responsible for everything she does.

    i have bore witness to a md screaming at a nurse to give a drug she should not give......."i'll have your job i'm the md i said give it" she gave it....she should not have given it......she lost her job and liscense. if they want it give i had them the syringe and suggest they give it themselves.


    here is the fda warning
    gov/cder/drug/infosheets/hcp/haloperidol.htm>.
    leslie :-D likes this.
  3. 1
    Quote from Esme12
    That is called Tartive dyskinesia, You seem to have a lot of information about this patient, his family, and his care.

    Many drugs have serious side effects that can lead to death. All professionals involved are responsible to check and recheck to prevent these type of unfortunate events. Haldol is contraindicated in other disease entities. Not all states require informed consent for restraint or drug administration. The MD should be aware of what they are ordering. The pharmacist should also be aware of the pt's disease process before filling the order and the nurse is responsible for everything she does.

    I have bore witness to a MD screaming at a nurse to give a drug she should not give......."I'll have your job I'm the MD I said give it" She gave it....she should not have given it......she lost her job and liscense. If they want it give I had them the syringe and suggest they give it themselves
    Thank You Esme and God Bless you for your efforts on your patients behalf, I can't help but chuckle on your comment you hand them the syringe, a very admirable approach to what sounds like a self righteous MD, all patients need caregivers such as yourself that are not simply cashing a check, but have a genuine concern for their patients, and as you bond with your patients, I do too with the PD patients and families that I educate on their affliction and for some reason doctors don't relay the information that I do to them. and getting on board after the fact some families seek answers that go beyond the blind trust they bestowed on their MD's.
    To see the grief on the faces of families who all share the "If I Only Knew, They Would Still Be Alive" syndrome is actually heart breaking, so on their behalf, yes I take their pain very seriously, as we all know some folks get the best of care and just die, others have foreseeable errors take place and die, it is the loved ones of those folks that deserve closure as well. and in most cases I am the first one to say "I'm sorry they did all they could" but in this case I just don't have that opinion.

    It's ironic that you mentioned dyskinesia, that can and will become present in PD patients with long term Parcopa/Levodopa intake, before I reviewed the charts I thought to myself, maybe just maybe the MD was ordering haldol, because he mistook typical tremors for dyskinesia and thought haldol might back some dopamine out of his system but currently, amantadine is the only drug that reliably reduces dyskinesia without worsening the motor symptoms of PD, but the drug has other side effects that are undesirable and its motor benefits do not last long, allot of folks see PD suffers shaking and think they need meds, when in actuality it is the meds making them shake, pd patients without meds "Freeze" thats why stage 5 PD is so terrible to watch the patient no longer responds to his meds and becomes frozen in his bed.
    You mentioned the pharmacist in this case the daughter brought his meds from home day 1, and as you all know meds brought into the hospital must go to the pharmacist first for approval.

    It seems like one of the post's stated Haldol just seems to be a prerequisite to being on the floor
    And like one of the post's says to "Push" such a nasty drug to a elderly patient lying in bed with a broken hip with his arms shaking from his PD just seems irreproachable.
    Its seems harsh for me to say but sometimes is the sad truth, a patient is given a drug that causes agitation, then is given a worse one to calm it.
    When the laymen looks at that scenario it does not make sense.
    Esme12 likes this.
  4. 0
    Wow...my brain hurts a little, but this was great education. I think of my PD residents right now and their PRNs and I think they're ok, but I will be double checking tomorrow when I go to work.

    I wish there was an easy way to save this thread to my computer for future reference. This type of thread is why I love allnurses.com! Thanks for all the great information!
    Last edit by pedsrnjc on Oct 14, '10 : Reason: spelling
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    Quote from LTC RN jc
    Wow...my brain hurts a little, but this was great education. I think of my PD residents right now and their PRNs and I think they're ok, but I will be double checking tomorrow when I go to work.

    I wish there was an easy way to save this thread to my computer for future reference. This type of thread is why I love allnurses.com! Thanks for all the great information!
    Yer Welcome LTC and I take it most of your pd patients are elderly please remember the half time of the drugs you give, the dosage, an adult dose is way to much for elderly, think of them as infants, you can always give more, to much is to late, pd patients often develop "sundowners" don't let it alarm you often you can calmly talk them out of it, PD dramatically throws your orientation off, you become very confused and have great indecision, most elderly PD sufferers become "Hoarders" they think they are on track but can not make decisive decisions, calm relaxed talk does wonders for PD it causes them to focus, but of course that requires a nurse willing to sit with a patient and calm them, just a caring voice is soothing and of course so non invasive, sounds silly but if you have time give it a try, sure beats pumping them full of drugs but does require a loving caring approach, something 40 years of nursing school wont teach you
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    PA does not have a specific law re meds and elderly. Moved thread to Med Savy forum to help educate nurses + nursing students.

    Parkinson's List Drug DataBase haloperidol / Haldol,Serenace
    Haloperidol is contraindicated in patients with Parkinson's disease. The dopamine blockade from haloperidol will dramatically worsen the preexisting Parkinson's disease, possibly incapacitating the patient.
    The Parkinsn List Drug Database The Parkinsn List Drug Database lists over 140 drugs that Parkinson's patients might encounter. The reports on each drug detail the side effects and contraindications of each compound. Drugs that the Parkinson's patient should not be given post-operatively, which could exacerbate the Parkinson's, are also detailed.


    Nurses should be aware of Beers Criteria (Medication List):
    Potentially Inappropriate Medications for the Elderly According to the Revised Beers Criteria
    See list posted @ Duke University:
    Beers Criteria (Medication List) dcriorg
    Last edit by NRSKarenRN on Oct 19, '10
  7. 0
    Quote from LTC RN jc
    Wow...my brain hurts a little, but this was great education. I think of my PD residents right now and their PRNs and I think they're ok, but I will be double checking tomorrow when I go to work.

    I wish there was an easy way to save this thread to my computer for future reference. This type of thread is why I love allnurses.com! Thanks for all the great information!
    LTC this is why I mentioned to take a "Less is More" approach t sedation in your PD and Elderly Folks

    The Role of Sedative and Analgesic Medications
    Psychoactive medications are the leading iatrogenic risk factors for delirium. Benzodiazepines, narcotics, and other psychoactive drugs are associated with a 3- to 11-fold increased relative risk for the development of delirium.In addition, the number and rate of adding psychoactive medications increase the risk of delirium by 4 to 10 times. Extreme variability exists in the pharmacokinetics of these agents according to age, ethnicity, drug metabolizing ability, and other factors. In fact, the half-life of narcotics can increase 6-fold in critically ill patients and the elderly. Although the use of sedatives and analgesics clearly has a major impact on length of stay and other outcomes (data presented in the following text),the impact on neuropsychological outcomes from these extremely commonly used medications in ICU patients is not known. The American Psychiatric Society has recently published its guidelines on delirium, which included a list of substances that can cause delirium through intoxication or withdrawal
  8. 0
    These are just not questions we can provide. Please contact the hospital and sit down face to face with them.


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