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?
The doctor prescribed it knowing the risk of interacting with meds. But it seems the benefits outweigh the risks. No different than prescribing any other med. It should be more common in my opinion. That way we wouldn't have so many delirium tremons patients with all the risks associated with DTs.
The doctor prescribed it knowing the risk of interacting with meds. But it seems the benefits outweigh the risks. No different than prescribing any other med. It should be more common in my opinion. That way we wouldn't have so many delirium tremons patients with all the risks associated with DTs.
A lot of people don't realize how high the mortality rate is from DT's. It's not just simply a pain in the rear for caregivers, it's very dangerous for the patient. My first patient in the ICU had come in for a really minor surgery, went home, had bleeding complications, and came back in for that. Went into DT's, began running a fever, eventually went into total organ failure. The doc told me that patients who go into DTs and become febrile have a mortality rate of over 60%.
My sweet old grandmother drank like a fish and smoked like a chimney. When she was in for her hip fracture, her old GP came in and wrote for "Spiritus frumenti ad lib." That was to keep her from doing withdrawal, and it worked fine. Anybody that does a case of bourbon every six weeks all by herself should keep getting it, even with her pain meds.
I've had several full blown DT patients over the years working in ICU. It's bad news I tell ya. Got a ETOH gtt going on one guy post CABG (back in the day) but it was too little too late. Guy busted his chest open not once but TWICE. He became a very sick man who lived in our ICU for a looooooong time. Obviously it isn't good to be addicted to ETOH but now with CIWA scoring we give boatloads of benzos to get someone through. It's gonna be one or the other.... neither really fall into the category of "healthy".
Now for those patients just wanting their nightcaps? Depends on the whole clinical picture. Just like "avoid or treat DTs?" ... it's not a one-size-fits-all.
My first nursing job was on a neuro/ENT surgical floor. Many of our facial/neck CA patients were chronic alcoholics, and to prevent DTs instead of a Valium protocol, the MD would order "1 beer per feeding tube TID." We fed it like a bolus feed into their PEG/NJ. Post surgical, they also took morphine/Dilaudid and oxy for pain (as you can imagine, it hurts to have your neck dissected or large portions of your face removed.)
I also worked at a SNF on the subacute rehab for a few years, and one of their weekly activities was happy hour. Our unit secretary set up in the dining room and gave cocktails, wine, or beer to the patients who wanted it. Most of them were on multiple meds, including narcs, as well.
I honestly wouldn't get too scared about it; I mean the pharmacist would have already reviewed everything and contacted the provider if anything was concerning. I'd bet that the reason the pt needs the whiskey to prevent DTs, and the risk of DTs outweighs the risk of the EtOH+meds.
This is common in my LTC facility. I have a lady who gets 2 shots of vodka and some OJ at 1600. She is a vietnam vet, bilateral leg amputee, and alert and oriented. QUALITY OF LIFE is vital.
If I ever end up in SNF, I may just have to ask for an order "Medicate until hammered"
Standing orders should read.. one shot every 30 minues until no pain is felt.
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?
In this case, whiskey is a medication. Know the rationale and admister as ordered.
It appears you have personal issues with alcohol.
If the patient WAS to develop pain.. you would go straight for Dilaudid?
I worked in a SNF and had a patient with a doctors order for QHS brady old fashion. The family supplied the etoh and it was listed on his MAR. Now I work in an acute med surg unit and we have a specific etoh withdrawal protocol that uses valium/loraz along with scheduled gabapentin in most cases. I have heard of using etoh in the past, but in this day and age meds are more appropriate.
I know this is not a religious board, and this is not a religious post so hear me out. This is written from a purely historical perspective. The Bible says to give alcohol as pain relief, and the Bible is the most enduring literary work in history, so even if that isn't your view, you've got to give it some credit that the most enduring literary work of all time recommends alcohol for pain/suffering
disclaimer: this is not saying to become an alcoholic, because that clearly only leads to other problems
emb92250
170 Posts
The doctor prescribed it knowing the risk of interacting with meds. But it seems the benefits outweigh the risks. No different than prescribing any other med. It should be more common in my opinion. That way we wouldn't have so many delirium tremons patients with all the risks associated with DTs.