Advice please regarding Dual Diagnosis

[Starcicles1]

I am new to the dual diagnosis patients and I was wondering, when patients are demanding medications that go against their treatment plan(ya know the Benzos and other controlled medications)

How do you effectively care for the patient when they are demanding the medications because "other meds aren't helping the symptoms and pain" What are some nursing interventions that are effective?

[vintagemother, BSN, CNA, LVN, RN]

If PRNs are prescribed, I give them. It's not my business to interfere with the meds that the psychiatrist has prescribed.

Non pharmacological approaches that I use include therapeutic touch and therapeutic communication.

Besides that, if they request and can communicate a therapeutic need, I give the prescribed PRN..

[vintagemother, BSN, CNA, LVN, RN]

I just re-read your question. So if a client requests meds not ordered, I obviously don't give them.

What I might do is do a quick focused assessment of their s/sx. If they don't have a med prescribed to help with the problem, I'll refer them to their psychiatrist and ask the client to communicate their concerns with the Psy D.

If my assessment shows a true urgent need, I may call the psychiatrist and ask for orders.

I don't label my clients as drug - seekers, but I will document if they are approaching staff super frequently for doses of narcotics without orders for the frequency they are requesting. I also document if they try staff splitting in order to get more meds than are prescribed.

We also have case mgrs/social workers who give verbal counseling to Pts r/t mgmt of addiction. We also offer addiction classes and I and the case mgrs encourage attendance to those who appear to need help.

I'm also still working on ways to support my clients besides pharmacological approaches. But I'm a new nurse still and don't have a large knowledge base on these approaches.

[Meriwhen, ASN, BSN, MSN, RN]

When it comes to medications that they aren't prescribed, I tell them that I can't give it for them no matter how much they demand it--only their provider can order it, and they can discuss it with them. I will notify the charge and the MD about the patient's requests so that we're all on the same page and to minimize staff-splitting or other attempts to get the med (e.g., "the doctor told me he would give me it and must have forgotten to order it!"). I'll explain--though usually with dual dx patients it's "attempt to explain"--to the patient why they aren't prescribed a particular med, such as the potential for cross-addiction or abuse, side effects with current meds, etc.

I'll try to teach them coping skills and non-pharmacological techniques to manage symptoms. I'll also offer whatever PRNs they do have ordered and encourage them to try it...and if they refuse the PRN, then I'll call them out on it ("well, I guess your anxiety must not be that bad if you don't want the Vistaril, let me know if you change your mind") and move on to the next patient.