So, the another night, we got a new admit. Along with this new person, amongst all the busyness that accompanies new people, was a strange order that made, and still makes, me nervous. Apparently, we are to give him whiskey along with his evening medications. This worries me since alcohol interacts with so many medications. Not to mention that, if we were to need to manage any pain, we would have to give dilaudid, which shouldn't be given with alcohol. It is an order, and he said he legally is able to do so, but it still makes me uncomfortable. It doesn't seem right as part of my nursing duties to be giving patients alcohol.
Has anyone ever heard of this? Am I right to be leery about this order?
Everyone who has an occasional, or even every day glass of wine or an ounce or two of liquor, is not an alcoholic. They are not going to go into DT's. You might want to look into alcohol and addiction.
I think that you are the one who needs to be educated! Go to an Alcoholics Anonymous meeting and ask someone there if a person HAS to have a glass of wine/whiskey/beer on a daily basis is an alcoholic or not. An alcoholic is not just someone on the street corner with a paper bag.
I drank for years and guess what?? never had DT's and i'm an alcoholic!
The sad part of this is that the medical professionals that are talking to patients are ignorant to the facts surrounding alcoholism and addiction..again, you don't have to have DT's to be an alcoholic!!!!
These posts are actually scaring me.. to think that a good portion of the nurses that are posting here agree with giving a patient in the hospital alcohol, just so they don't go thru dt's?? or so they don't annoy you all night???or because they will just go back out and drink again???
I get alot of detoxers on my unit, we do give ativan/librium/valium to detox them, they are not going cold turkey. Yes, CIWA's might be annoying but neccessary. To say that these patients are going to go back out and drink again away is crazy! Ive seen people come to the hospital many times and then finally stop because we didnt give up on them. It only takes one drink for an alcoholic to get started again and sometimes just one person can make a difference. Just think if this were your mother,son,daughter..you would want someone who is actually educated about alcoholism to talk to them and care for them.
They did give alcohol a long time ago in hospitals, with education better options became available and the medical community unanimously agreed that alcoholism is a disease.
Alcohol given in an LTC setting is totally different. They are residents in a community, that is there home and they are not detoxing.
I work in a hospital and we don't just "give ativan" to someone who drinks and has potential for DT's. We use an alcohol withdrawal scoring system; depending on their score (done q2hr) we give them librium. If they are unable to take p.o. librium, we give them IV valium, but only if their score is high enough to need it. Many of our drinkers never score high enough to even get the librium. Fortunately, this really helps prevent DT's. We NEVER try to discharge them within the "magical 3 days" solely because they might go into DT's! Oh, and for those that might not know, DT's can be very dangerous. It is better to try and prevent them.
These posts are actually scaring me.. to think that a good portion of the nurses that are posting here agree with giving a patient in the hospital alcohol, just so they don't go thru dt's?? or so they don't annoy you all night???or because they will just go back out and drink again???
I get alot of detoxers on my unit, we do give ativan/librium/valium to detox them, they are not going cold turkey. Yes, CIWA's might be annoying but neccessary. To say that these patients are going to go back out and drink again away is crazy! Ive seen people come to the hospital many times and then finally stop because we didnt give up on them. It only takes one drink for an alcoholic to get started again and sometimes just one person can make a difference. Just think if this were your mother,son,daughter..you would want someone who is actually educated about alcoholism to talk to them and care for them.
They did give alcohol a long time ago in hospitals, with education better options became available and the medical community unanimously agreed that alcoholism is a disease.
Alcohol given in an LTC setting is totally different. They are residents in a community, that is there home and they are not detoxing.
Because giving narcotics is soooo much better for your health LOL.
DTs are no joke and people die from it, personal experience here working on a tele unit next to 2 large reservations. A severe alcoholic is not in good medical shape to begin with, not to mention why they are there. Then to throw DTs into the mix? No way. The hospital is not a detox center, the hospital is a place to medically stabilize patients who then can be sent to a place to detox and recover.
What I think most people here are saying is that alcohol is a drug, like any other drug. It is not magical, it is not evil, it is just a drug. I personally believe it is a highly underutilized and effective drug.
Patient safety and patient comfort are far more important than our own individual social justice crusades.
Responding to orders for alcohol. I have seen this many times before, usually wine. There is a list available of medications that do not mix with alcohol which I consult often. I also have a problem I could use advice with. I have been working in a LTC facility for nine months. A great majority of our Residents were homeless before being admitted with a qualifying event under Medicaid. I am told they cannot be discharged until a safe discharge can be planned. Hence, they stay indefinitely. These are independent men that leave the facility in the morning and return after drinking alcohol for most of the day in the evening, my shift. They also keep alcohol in the facility. We also have four men who panhandle in the town during the day to purchase the alcohol. These men act as if the common area is a bar, foul and wreaking of alcohol, nightly. Of course, there are altercations and the Police are called. We have no security. The corporation has informed us "this is the new norm as the Baby Boomer generation won't be told what to do." I have contacted the Ombudsman and was told "the facility is their home and unfortunately adults make bad decisions." The doctors are aware of the ETOH consumption. I hold their medications when they are visibly under the influence. However, as most of us know, alcohol consumption can be well hidden. I love my elderly patients, that is why I choose to work LTC. The "new norm" is ranging from 42 to 67. Is anyone else working in this type of environment, and, if so, any coping tips?
I've had patients who had a nightly highball ordered. Pharmacy sent up whiskey (long pour) and I mixed it up. As others have noted, some patients have beer ordered and got it.
Except one patient who punched me. I used to be a bartender; if someone punches me, I don't serve them any beer.
Also, for those that have given alcohol to your patients, have you given it with the meds? Or spread it out?
I spread it out. I try to put at least 2-3 hrs between the alcohol and med pass. There's nothing in our facility policy that spells it out, just that alcohol shouldn't be given within 4 hrs of administering oxycodone.
I work in LTC. Our residents have standing orders. They can have 4 oz of whiskey, beer or wine with dinner. We keep the alcohol locked up in the med room fridge. Family supplies their choice of alcoholic beverage.
These posts are actually scaring me.. to think that a good portion of the nurses that are posting here agree with giving a patient in the hospital alcohol, just so they don't go thru dt's?? or so they don't annoy you all night???or because they will just go back out and drink again???
I get alot of detoxers on my unit, we do give ativan/librium/valium to detox them, they are not going cold turkey. Yes, CIWA's might be annoying but neccessary. To say that these patients are going to go back out and drink again away is crazy! Ive seen people come to the hospital many times and then finally stop because we didnt give up on them. It only takes one drink for an alcoholic to get started again and sometimes just one person can make a difference. Just think if this were your mother,son,daughter..you would want someone who is actually educated about alcoholism to talk to them and care for them.
The thing is, if they're not interested in detoxing, it won't matter how much Librium or Ativan or whatever we give them. It's not going to stop the alcoholism. They aren't going to magically detox, then get discharged and go straight to an AA meeting....unless they were already ready to do that anyway.
Yes, alcoholism is a disease. Several family members with it. But it is a disease that will not be cured until the person is ready to quit. I can want them to stop all day long, but until they want that for themselves it is not going to happen.
And honestly....if I live to be 96 years old and I go to the hospital, nobody better tell me I can't have my Cuba Libre or my Mountain Dew and Oreos or whatever the heck I want at that age.
I have had quite a few patients with liquor orders... I worked in a rural retirement home for a bit, and many of the doctors had written orders for "1 pleasure beverage of choice at hs" and one doctor said he preferred to see his patients have a small glass of wine over taking a narcotic sleeping pill. where I work now, in a rehab facility, I've had a few doctors say these patients are adults, if they want a beer with dinner, they deserve it. It can't be any worse than any other med we administer... many have some really horrid possible side effects and bad interactions, and we take those calculated risks daily.
If someone truly is in danger of going into withdrawal, one glass of wine is not going to stop it. t
I worked in an STR and a Dr did order a glass of wine with dinner for a patient who normally did this at home but not because he didnt want her to go into withdrawal.
If this patient is in a hospital setting how about giving Librium to ward off DT's thats our protocol...just a thought.
I think that you are the one who needs to be educated! Go to an Alcoholics Anonymous meeting and ask someone there if a person HAS to have a glass of wine/whiskey/beer on a daily basis is an alcoholic or not. An alcoholic is not just someone on the street corner with a paper bag.
I drank for years and guess what?? never had DT's and i'm an alcoholic!
The sad part of this is that the medical professionals that are talking to patients are ignorant to the facts surrounding alcoholism and addiction..again, you don't have to have DT's to be an alcoholic!!!!
You are responding to someone who noted that having one or two drinks a day does not make then an alcoholic. That statement is certainly true. You don't have to have had DTs to be an alcoholic, but a history of overconsumption of alcohol is just about 100%.
I grew up in a family full of alcoholics. I've treated more than I can ever count for acute withdrawal and countless other chronic complications. In not ONE of those instances did any of them drink one or two a day. Not a single one.
There are rare instances alcoholics who have reduced their consumption to one or two a day and they end up a patient (usually for chronic ETOH problems). However, if that person has been told to NEVER drink again, no Dr. should order alcohol for them. The patient is going to be pissed about this and may get a low dose benzo order for their hospital stay. Same goes for patients in "wet houses." No, you won't get alcohol in the hospital. If they don't like it they can leave.
workinmomRN2012, BSN
212 Posts
I think that you are the one who needs to be educated! Go to an Alcoholics Anonymous meeting and ask someone there if a person HAS to have a glass of wine/whiskey/beer on a daily basis is an alcoholic or not. An alcoholic is not just someone on the street corner with a paper bag.
I drank for years and guess what?? never had DT's and i'm an alcoholic!
The sad part of this is that the medical professionals that are talking to patients are ignorant to the facts surrounding alcoholism and addiction..again, you don't have to have DT's to be an alcoholic!!!!