Ambien "holiday" substitute??

[444bkids]

I am an RN in a short-term rehab facility. Our patients are primarily p/s ortho, elderly but alert and for the most part oriented, and absolutely HATE the 9th day Ambien holiday. They are very savvy about their meds, very aware when their Ambien is not present, and they will literally psych themselves out so badly over this that some will stay up practically all night. Does anyone have any ideas about a candy, placebo pill, or something that would resemble the little purple pill that we could use to "fool" them? Smarties are too large, and they are the only things I have seen that even remotely resemble it. We are not trying to be unethical, but their overall rehab goal is hindered when they aren't rested. Any suggestions?

[PetiteOpRN]

Unless the patients are enrolled in a study and sign a consent stating that they understand they might be given a placebo without their knowledge, it is categorically unethical to give someone a "sugar pill," even if your intentions are good.

Patients have the right to know exactly what you are giving them. Giving them a sugar pill is an attempt to deceive them. What would happen if the patient on the "holiday" gets the sugar pill and still can't sleep. They might tell their doctor that they need their dose increased, or might suppliment in some other way. Just a dangerous idea all the way around.

[blondy2061h, MSN, RN]

I've never heard of an "ambien holiday."

[Pepper The Cat, BSN, RN]

What is an Ambien "holiday"? Is this part of being on Ambien or is this a policy of your unit? What is the purpose of the holiday? Can you provide a different sleeping pill on those nights?

[klone, MSN, RN]

I used to take Ambien regularly, and I've never heard of an Ambien holiday.

I agree that it's completely unethical to give a placebo without their prior consent.

[SlightlyMental_RN]

Are you kidding? Please tell me that you are kidding. There's just no way that I can even imagine an actual RN posing this question, as we're all required to know and understand such ethical questions. Additionally, I've never heard of such a thing as an Ambien holiday, and I've worked in an ortho/surg short-term rehab facility, a nursing home, clinic, and hospital.

[Sparrowhawk]

Me...five. I've never heard of it.

[TDCHIM]

Did your patients sign a consent for this sort of thing upon entering your facility? I've certainly heard of holidays for other drugs that have addictive potential, but what do you mean by a "9th day Ambien holiday?"

[blondy2061h, MSN, RN]

Also worth mentioning, my facility's policy is that placebos require an order like any other medication (once the ethical issue is overcome- we often use placebos because we often do drug trials). Even if the patient is enrolled in a trial, once we go to give them the trial medication we have to present it as "This is your trial medication or a placebo," we can't just say that we are giving them their trial medication.

[ObtundedRN, BSN, RN]

I've heard of Ambien holidays before. But they only did it for one night every 30 days. Something about the patients couldn't be on ambien for longer than 30 days. So the 31st day would be a night off, and then they could start back.

Have you tried talking to the doctor? Maybe try something else during your ambien holidays? Or something else all of the time?

[cmonkey]

My ambien holiday is falling asleep with my pharm book on my chest. Maybe your facility could hand out textbooks.

[favthing, APRN]

I have a resident who was ordered Ambien CR by an NP, and it was for 9 days admin, and then off for the 10th day. I asked why, and he referred to this as correct practice if Ambien is to be given as a continuous order rather than a prn. He said that first of all Ambien should be short-term anyway, or prn. If to be given q h.s., then the responsible and correct way is to order with a 'holiday' so that pts won't get used to it so it stops working. The MD was in another day, and I spoke with her about the order, and possibly something to give during the 'off' day of Ambien since she said absolutely, the correct way of prescribing is as the NP ordered.