Another ethical med question

[blondy2061h, MSN, RN]

A recent thread about giving meds down an ng tube without the patient's permission brought this question to mind.

If a patient is sleeping and have IV meds due, and you can hang the drug easily without waking them, do you wake them to ask if they want the medication?

I don't, especially given that my patients often get IV meds hourly, and obviously want a chance to sleep. Also, I often have my patients many days in a row and know they have no issues with taking their meds.

However, isn't the right thing to do technically to wake them up and get "informed consent?"

Occasionally I'll tell them before they go to sleep what they'll be getting that night. I guess that's actually the right thing to do.

[Tait, MSN, RN]

They signed informed consent when they walked in the door and signed the general consent to be treated.

Let them sleep, give your meds.

The only thing I will wake a patient for is if they have asked me to bring a PRN narc in when it is next available for pain and they are asleep, and then even half the time if they don't awake to the soft patter of my feet on the linoleum I leave them be until they do wake up. Assuming they are comfortable enough to sleep. If I have a patient adamant about a PRN I will ask them if they "want" to be woken for it, or if I can pass on it if they are alseep. (Though I had a very ungrateful patient holler at me at 645 the other morning because I didn't wake her for her 0600 percocet, which was an hour after I gave her 10mg PO Toradol. And this was after a very successful night of keeping her comfortable and rested).

Tait

PS. And I also tell them "just so you know if yo hear me sneaking around at 4am its just antibiotic time." However that is just a courtesy at that point, not an attempt to ascertain consent for the medication.

[nursemon]

I would not wake them either. I agree with the previous reply that I would let them know ahead of time, like when you do your first assessment of the shift-I say to my patients "I won't be waking you up tonight unless I need to so you can get your rest, but I will be hanging IV meds or giving meds through your IV." That way they know and I have never had a pt refuse it.

[firstyearstudent]

I decide on a case-by-case basis based on what the medication is, side effects, whether they've been getting it previously, and whether I believe the patient would want to be awakened. For instance, for most patients I would hang IV antibiotics that they had previously been ordered and received without awakening them.

But I might wake the patient if if they were getting something for the first time to make sure they weren't allergic (penicillin for instance) or to warn them of side effects (vanco for instance).

I would never hang chemo without waking someone up because it is our hospital policy to verify identity with two nurses, not just via bracelet but by confirming verbally if they are capable of responding.

I would also not give a sleeping patient a diuretic like Lasix because they need to know that they will have to pee soon and a lot. I have also woken patients that I know are very concerned about the drugs they are getting (some keep a notebook and write down all the times and doses).

If it is a psychoactive medication, like Haldol or even Ativan that they are scheldule ATC (as opposed to PRN) I would also wake the patient to tell them and give them an opportunity to refuse.

Basically I try to use the golden rule when I don't have a clear idea of the patient's desires -- "Would I want the nurse to wake me?"

[RochesterRN-BSN, BSN, RN]

I think Tait covered it well......that's exactly what I would do. You will find that it isn't all that often--unless you are in psych--that patients will refuse meds.

[CathyLew]

Since I worked nights so long, I got in the habbit of giving a brief run-down of what they needed the rest of the night. Since often times procedures or treatments were scheduled at odd hrs... like resp treatements scheduled at 1am, 2am etc... on someone who was past the distress phase... Instead of waking them up and having them get ticked off and refuse the TX, I would tell them at the beginning of the shift which things they absolutly need. i.e. antibiotics, steroids, etc, and which things they could refuse ahead of time. if the MD never made their treatment PRN, I tell them they can refuse the 1am TX now, and they could call anytime they were awake and get it.

same with IV meds, I tell them ahead of time their med schedule, and tell them they may see me hang a piggyback, or adjust the pump, and ask if that is ok, of do they want to be woken up.

when I was in the hosp, on my own floor...I told the nurses that if anyone wakes me up for midnight vitals, they were done for.

I have seen nurses wake up a patient to re-assess pain.... now, if you gave pain med, and they are snoozing... fill in the non-verbal asses for your pain assessment! Don't wake someone up just to get a 1-10 number.

now, to the question of NG meds.... I would say you would have to wake the patient. I would check the NG placement with air prior to giving meds, and the cold stethescope on their abd would be enough to wake anyone! I would need my liquified meds, and something to flush the line with... and want to see what I was doing. If they have an NG, chances are they are ill enough to warrent a full assessment at med time anyway.