IM meds question

  1. 0 Hi everyone!
    I have a question regarding PRNs. Say a psych patient has an order prn ativan 1 mg PO/IM for severe anxiety. If said pt suddenly became an acute danger to self/others but refused this med PO, could this med be given IM to them (over their objection) due to the emergent situation? What I am getting at is, I know this would be ok if the PRN was written for 'agitation' but what if it was written for 'anxiety' as in the above example? Am I splitting hairs? My gut tells me thatyou would administer the med to protect patient/others in this scrnario, and I'm probably over thinking this, but just wanted opinions.
  2. Visit  sassifras85 profile page

    About sassifras85

    Joined Feb '14; Posts: 4; Likes: 6.

    18 Comments so far...

  3. Visit  lovenotwar14 profile page
    0
    I thought that administering medication without patient consent is battery? If you feel that the patient needs this medication and his/her mental capacity doesnt allow for him/her to make adequate decisions regarding his/her health then you would need to gather more information to go through proper channels to have someone appointed over this patients care decisions.
  4. Visit  sassifras85 profile page
    5
    Are you currently a psych nurse? If a patient in an acute, emergent risk to themselves or others (whether voluntary or involuntary patient) they can be medicated over their objection in that acute situation. Now, you can't g o and force a standing, daily medication over their objection until your state's requirements for initiating that process are fufilled. If a patient was actively cutting their wrist with a knife, for example, and wouldn't stop and wouldnt take a PO med willingly to help them cease this acutely life threatening detrimental behavior, then administering the med IM is appropriate. In fact if you didn't medicate them in this situation, in an effort to help intervene and cease the behavior, and say they ended up severing an artery, you would be in a very bad position as a nurse. Battery wou ld occur if you f orced a med on a patient in the abscence of an acutely emergent situation (ie they said/did something you didn't like but which did not meet criteria for an acute emergent situation in which they were risk to self/others).
    Orca, metricalpound, macfar28, and 2 others like this.
  5. Visit  Meriwhen profile page
    7
    I'd give it. Consider the safety of the milieu: if a shot of lorazepam is going to fix an emergent situation, whether it's got "anxiety" or "agitation" next to it in the MAR isn't that important, IMO. Before or immediately after administration, I'd let the MD know what happened and why, as well as chart it extensively.

    However, to CMA I would not make a routine practice of it. I'd talk to the MD and either get the order changed to "anxiety or agitation" or have them order a PRN specifically for agitation.
    Orca, WillyNilly, jmiraRN, and 4 others like this.
  6. Visit  MrChicagoRN profile page
    5
    Quote from lovenotwar14
    I thought that administering medication without patient consent is battery? If you feel that the patient needs this medication and his/her mental capacity doesnt allow for him/her to make adequate decisions regarding his/her health then you would need to gather more information to go through proper channels to have someone appointed over this patients care decisions.

    If it was routine medications, you'd be correct.

    However, emergency medications may be given (in most/all? states) without consent to reduce/prevent danger to self or others.
    Orca, jmiraRN, macfar28, and 2 others like this.
  7. Visit  TerpGal02 profile page
    4
    Yup if it's an emergent situation, you give the IM. And for most of our pts, they agree to emergency meds when they sign the consent for treatment. Even if they refuse to sign, emergency meds are emergency meds. In an ER situation where you have a pt coding, you don't NOT give ACLS drugs because the person is unable to give consent. The situations in psych where IMs are necessary are the psych equivalent of a code blue (we call psych emergencies code green in MD). Granted the administration of prns is sometimes abused by staff, which should never be the case. I cringe when I hear staff threaten pts with IMs in a situation where it isn't warranted.

    I dunno, sometimes with really psychotic pts I almost think some of the PO PRN orders should he written as standing orders (ie 5 mg Zyprexa Zydis q 6). A lot of times those pts NEED that medication to clear up. I say that because I have seen the level of distress these pts are in when they DON'T get their PRN. Scheduled doses are not enough a lot of the time to bring someone around.
    Orca, jmiraRN, elkpark, and 1 other like this.
  8. Visit  KelRN215 profile page
    3
    Quote from lovenotwar14
    I thought that administering medication without patient consent is battery? If you feel that the patient needs this medication and his/her mental capacity doesnt allow for him/her to make adequate decisions regarding his/her health then you would need to gather more information to go through proper channels to have someone appointed over this patients care decisions.
    In the OP's scenario, the patient is an acute danger to himself/others. While you're calling to try to get a judge to appoint someone his legal guardian, he's trying to strangle his roommate or is throwing chairs in the common room. In reality, you call for reinforcements (this would have been security when I worked in the hospital), restrain him and medicate him.
    Orca, jmiraRN, and loriangel14 like this.
  9. Visit  Carrie RN profile page
    2
    Psych is a different breed of cat. I would give the med and document had severe anxiety demonstrated by behaviors of...then call the MD or whomever is to be notified.
    Orca and pinkiepieRN like this.
  10. Visit  anon456 profile page
    3
    I know nothing about psych nursing, but I am thinking 1mg Ativan won't do much. I give that much to my 7-8 year old patients.
    pinkiepieRN, KelRN215, and loriangel14 like this.
  11. Visit  Carrie RN profile page
    4
    Quote from anon456
    I know nothing about psych nursing, but I am thinking 1mg Ativan won't do much. I give that much to my 7-8 year old patients.
    It is the fact that a nurse gives multiple scheduled psychotropics in addition to the 1 mg of Ativan that it is effective.
    Last edit by Carrie RN on Feb 5, '14 : Reason: word missing
    Orca, Retired APRN, pinkiepieRN, and 1 other like this.
  12. Visit  anon456 profile page
    0
    Quote from Carrie RN
    It is the fact that a nurse gives multiple scheduled psychotropics in addition to the 1 mg of Ativan that it is effective.
    Ah! That makes more sense.
  13. Visit  Umberlee profile page
    0
    We can't have PRN IM meds pre-ordered here, unless there is just some physical reason why the person can't swallow the meds or something. We can have PO meds for anxiety or agitation but if the patient refuses them then we need to call the provider and get a one-time dose for an emergency injectable, and with that comes the order for the restraint we'll undoubtedly have to do to medicate them against their will.

    We have had quite a few providers recently writing orders for PO or IM meds but management is putting the kibosh on that due to the fact that it could be construed that we have standing orders for involuntary E-meds, which is not allowed. Possibly that varies state-by-state since I'm the only one on the thread so far bringing it up, dunno!
  14. Visit  TerpGal02 profile page
    0
    We usually have to call for an IM as most pts are not admitted with prns. The only exceptions are when we are getting someone we know is violent or they have prns at home (and that's usually a benzo). They only pre order IMs in the former case.


Nursing Jobs in every specialty and state. Visit today and find your dream job.

A Big Thank You To Our Sponsors
Top
close
close