Sleeping pill at THIS time????

Nurses General Nursing

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I work the night shift and I've heard other nurses say they never give a patient a sleeping pill later in the shift as the morning is approaching... or even 2-3. I say who cares? If it's ambien 5mg q HS prn... does that mean if the patient didn't take it between 8pm-1am then they can't have it at all? Why does it matter when they sleep... it's not like they have to get up at 7am to go to work. They are just sitting in the hospital all day watching TV or talking on the phone... what does it matter when they sleep... if the patient specifically requests a sleeping pill at an odd time, I think it would be appropriate to explain to the patient that it may mess up their sleeping schedule and that they may only have 1 dose in a 24 hour period but if they still want the sleeping pill I don't see how you could tell them no. It's really not my business when they sleep. Is "HS" really a specific time? It stands for within an hour of sleep. I work night shift so my HS is between 10am-12pm. I take my sleeping pill around that time.

I would try to avoid giving a sleeping pill to a pt during the day if it's a once-daily dose, because to the "normal world", HS is at night.

What bugs me about sleeping pills is having a pt awakened for VS after the pill is given. My mom was in the hospital 3 weeks after she had her stroke, and she would go to sleep after getting a pill, only to be awakened by the night shift for VS and then would be unable to get back to sleep. I finally asked the doc to write orders to leave her alone after the pill was given.

I get what you're saying, rest is very important, but isn't it also very important to regularly monitor VS in a pt with a new onset CVA??
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About the food and nutrition aspect, where I work the patient calls for their meals and room service will come and bring them whatever they want (as long as it's in accordance with with diet) and whenever they want it. The meals don't just come at certain times and either you eat it or you miss it. It isn't like that. Not that this is going to change anyone's mind about the ambien thing.

Honestly, I don't think I've ever given ambien past 2am. I just think it wouldn't be that big of a deal except for stress tests and PT. But not everyone is scheduled for a stress test and not everyone gets PT. I'd just rather have them sleep late later rather than not at all... if that is the patients true wish and they understand the risks involved with sleeping late. Sleep deprivation isn't good, either. Some doctors come early and others come much later in the day. What if they're sleep deprived all night, and all morning, and then finally fall asleep at 5pm when their doctor comes in to talk to them. The patient does have a right to sleep anytime they want, whether you give them ambien or not. They have a right to leave AMA. They have a right to refuse PT and their stress test. All I can do is educate them, but it's up to them to make their own decisions. I say if it is something does does create a problem, there's nothing wrong about getting a specific order from the MD about not giving it past a certain time. HS is an ambiguous time. But I've never had a problem waking people up at 6am after they've had an ambien at 12 midnight or 1am, so I don't think it typically knocks people out for that long.

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Specializes in LDRP.

Actually, isn't HS considered 2100 in the hospital? ya know, like achs accuchecks, the hs accucheck is 2100? etc etc

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When I had West Nile last summer, I would have been furious if I had been denied a sleeper because it was too late...I have been on a night shift schedule for years and I have a hard time adjusting to sleeping at night. :no: I wasn't having labs, I wasn't having x-rays, I wasn't having PT or OT. More or less I was there for IV fluids and antibiotics (ended up with a bacterial infection too) and REST. My head hurt so bad and I was so naseous that the only thing that brought relief was sleep...I got Ambien at night and Temazepam during the day. I love my doctor...he was the only person who really understood me when I was that sick.

:selfbonk:

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I work LTC, which isn't mentioned in this post, but when a pt had a sleeper later in the 11-7 shift, and I come in at 7 to give them their meds and get them ready for any appt's, tests, PT, OT, or even a family visit, it's not easy to rouse them and they're an increased fall risk. It's also not mentioned here, but some nurses on 11-7 regularly ask that pt's be medicated with any prn sleepers, antianxiety, or pain meds "to make their jobs easier". I DO NOT do that when I'm on 3-11. If they want to rationale why all the pt's needed all their prn's, so be it, but I think it's a form of chemical restraint to make the shift easier for 11-7. Before anyone flames me, I've done 11-7, and know it can sometimes be challenging.

If I'm on 3-11 and a pt asks for a sleeper before I leave, I'll give it. If I'm on 11-7 and they ask at 4 am, I'd check what other meds they're on, the side effects (sleepiness), and what they have planned for the next day, so they're not groggy all day, and consider an anti-anx. if they have morning "plans". It should be a case-by-case basis.

Take the next shift into consideration, and what activities the resident needs to do also.

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Specializes in Cardiac.

I've found that if a pt didn't sleep well the night before, then they will just end up sleeping all day anyway. Their body needs sleep more than they need a circadian rhythm.

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I never give sleeping pills past 2am. I do what was earlier mentioned- I will give something else that does not last for eight hours. There is usually a reason they are awake- if it is pain, they will be much better served by pain medication that only sedates them for a few hours.

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There are few exceptions but generally no reason to give a med to make a pt sleep while the sun is shining.

Does that include phenergan and pain meds too? Or were you just referring to sleeping medications?

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Specializes in Oncology/Haemetology/HIV.
Well, I think that if given a sleeping pill too late in the night, say, after 2a or so, that they might be too sleepy to participate in any tests they have scheduled. quote

I agree with the above. Don't work nights now, but we wouldn't give sleeping pills after 2 a.m., they'll be asleep all day.

I wouldn't give a sleeping pill during the day unless it was ordered to be given that way.

For one, many MDs will DC the sleeping pill if it interferes with the tests/care/AM interview with the patient. It is almost automatic that if the patient is too groggy on rounds that the sedatives will be DCd. Not my or the patient's choice but the MDs.

The patient is not home and not here to rest at his/her convenience. They are here for specific purpose, and sleeping is not it.

That said, I try to let my patients get as much uninterrupted rest. And as a nightshifter, it is a pain to re-set my clock. But one is in the hospital for a purpose, and unfortunately sleeping through all the procedures, visits and tests interferes with that. You want to get that done, get out and go home to sleep.

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Specializes in Psych, Informatics, Biostatistics.

Our soft cut off is 3 am, BUT if the patient is acting out will give it to them @ 3:30 am. I mean in some cases it doesn't do anything anyway. Its usuaslly Vistaril and I am giving it to someone who is either dually diagnosed or has been taking meds since forever.

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