Being Ordered to Give Whiskey

[purplegal]

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?

[standardprecautions]

We have given a patient whiskey as ordered. It was a controlled portion to help him sleep, apparently. Patients who have the capacity to make decisions can decide whether they want to take alcohol or not even when they are in the hospital. In this case I honestly think that giving this patient his alcohol is more beneficial than harmful. If you still feel uneasy doing it, talk to your immediate supervisor :)

[Queen_of_Cardiology]

Here in the U.K., Many moons ago when I worked in an IP oncology unit, we had Patients who prn Guinness prescribes. Used to help with their low ferritin or improved their appetite. Seemed to be popular with the patients too. In the grand scheme of things, it didn't hurt anyone & gave very sick patients a great deal of pleasure, & was never given to prevent withdrawal.

[hppygr8ful, ASN, RN, EMT-I]

Also, I feel that keeping the alcohol locked up in our medication room, like we do with our narcotics, would better than keeping it in the refrigerator.

I agree with you there - Every time we have ever had ETOH orders the liquor was stored in the locked medication room.

Hppy

[everoo]

I had a pt in ICU who we gave a shot of vodka every evening mixed with orange juice.

He'd been drinking that one evening drink for decades. At that point in life, it helped him physically and mentally.

I had no issue giving it. Had he'd shown S/S of problems, I would have addressed it.

[aspiringrn1987]

I've had a LTC patient that was hospice and has orders for 4 oz of vodka PRN q day. The order specified not to give narcotics and vodka within 4 hours of each other.

[bdw062590]

Yep - covered this in lecture a few weeks ago and people were confused as to why. Alcohol can reduce stress, increase mood and stimulate appetite. Something I think most of us know

[TWD_RN]

@Ruas61, BSN, RN

Actually, that is not true. I work in a neuro/trauma ICU so we always get the really bad DT's. A woman in her 30's came in for back surgery and stayed longer than anticipated. As a result, she ended up going into DT's. she admitted to drinking wine and beer daily. I talked with her husband and mother who confirmed that she only drank wine and beer 2-3 glasses on average, but never liquor. They all where so shocked to hear that a little beer and wine could cause this response. Someone does not need to be an alcoholic to go through DT's.

[Nightshade1972]

My husband's a non-attorney hearing representative. He goes in front of a Social Security judge to explain why his claimant deserves disability benefits. Several of his clients over the years have had an order for alcohol in their chart, for the same reasons others have already stated here--they're dependent on it, and they shouldn't have to suffer through forced detox in addition to whatever other reasons they're in the hospital. When you're treating someone for, say, a burst appendix, that's not the time to also force them to instantly get sober.

[CarolinaRN1111]

I had a patient with an order for 30 mL with meals and HS. Without the whiskey, we would have had much more serious problems than his recent amputation. There was a bag in the med fridge with pre measured prescription bottles of whiskey. When we were down to one dose, we called the pharmacy and had to pick up more pre-measured bottles. I gave it with his 9:00 p.m. Meds along with 4 mg Dilaudid every four hours. In the beginning, I told the patient my "rules" for giving narcotics PRN and whiskey... "I will give you whatever is ordered by the physician. You have to ask for the pain medication. If your blood pressure has dropped below 100 sys, if you fall asleep while asking for pain meds, or if your breathing slows to under 14 breaths per minute, we need to hold off on the pain meds."

I have to say that he was the most delightful patient I had that evening and I would have never guessed he was under any influence.

[anitalaff, BSN, RN]

I had a patient on an alcohol drip once. ICU, not nursing home, obviously.

I would love to hear more about this if you can remember! Fascinating.

[anitalaff, BSN, RN]

There is also a prevailing sense of urgency among the nurses and the doctors to discharge them ASAP before the magic 3rd day where severe withdrawal tends to occur.

That sounds like an irresponsible way to practice! I'm so glad you disagree with it. Thank you for your thoughts.

[Elaken]

Honestly, I get frustrated by how infrequently doctors order it. When I have an ETOH patient, who is not there to withdraw and has zero interest in stopping drinking, what is the point of CIWA? How is it better to give Ativan all day than some alcohol? I don't see this order often and when I do it is more frequently with surgeries but I wish I did. It use to be a med delivered from pharmacy but now dietary does it and it is their alcohol type of choice (liquor, beer, wine).