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Holding HS Meds

Geriatric   (440 Views 11 Comments)

Newgurl17 has 2 years experience as a CNA, LPN and specializes in LTC.

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Hey all,

 

I'm still working in a special care unit. So I was working this evening with a lady who gets a scheduled Seroquel 25mg tab and a 50mg (I think) tab of a sleeping medication (trazadone). This lady was sleeping in her wheelchair after supper, had little intake at supper as per CNA. In report it said that she was slowly declining. 

She was able to wake up for me for a while. I decided that I would hold off on giving the seroquel and trazadone, as she was already so sleepy. Another tine she was with a volunteer who stated that she was tired at 1830 so the cnas put her to bed early. I didn't have a chance to give her her medications because she was sleeping. When she didn't have her medications, she was up at 0200 but she was helped back to bed again with no issues. 

If I was on another unit (not special care) in the facility, I would have held the antipsychotic and sleeping medication and that's what myself and other nurses were instructed to do? 

I only the held the meds tonight because I was afraid that this lady would be over-sedated??

 

Should I have given the medications?

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I do not know the routine or protocol of special care units. You mentioned that in other units you "we're instructed to" hold the medications.

In regular acute care hospitals you cannot NOT give a med without notifying the doctor.  I hope the "we're instructed to" on the other unit is backed up with written protocol.

We're any of these meds ordered PRN?

Unless special care units have some written protocol or policy,  a doctor must  be notified anytime a med (or treatment) is not given.

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Newgurl17 has 2 years experience as a CNA, LPN and specializes in LTC.

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22 minutes ago, brownbook said:

I do not know the routine or protocol of special care units. You mentioned that in other units you "we're instructed to" hold the medications.

In regular acute care hospitals you cannot NOT give a med without notifying the doctor.  I hope the "we're instructed to" on the other unit is backed up with written protocol.

We're any of these meds ordered PRN?

Unless special care units have some written protocol or policy,  a doctor must  be notified anytime a med (or treatment) is not given.

Meds were scheduled

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3,079 Posts; 44,669 Profile Views

Okay, so scheduled meds, what I said applies, the doctor must be notified, UNLESS there is a written protocol for patients in your special care unit?

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Newgurl17 has 2 years experience as a CNA, LPN and specializes in LTC.

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1 minute ago, brownbook said:

Okay, so scheduled meds, what I said applies, the doctor must be notified, UNLESS there is a written protocol for patients in your special care unit?

Usually we let the RN know what's going on, they give us direction, we continue to monitor, then notify the physician via fax, unless the resident's condition is more urgent, then the RN gives the on-call physician a call. In other instances, the nurse lead (an LPN or RN usually) may have us trial holding medications, like risperidone, if a resident is too sedated, then we fax the physician of the trial was effective to discontinue the order

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Great, that explains a lot.  Your protocol is to notify the RN, (and document that you did).  Did you notify the RN about holding the trazadone and seroquel?

I can completely understand why you held them, but it's still up to the doctor to decide if it's appropriate to hold them. 

I doubt that missing one dose of either meds is a problem. But almost all psychiatric mood altering meds, even when prescribed for sleep, cannot be stopped abruptly.

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Newgurl17 has 2 years experience as a CNA, LPN and specializes in LTC.

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7 hours ago, brownbook said:

Great, that explains a lot.  Your protocol is to notify the RN, (and document that you did).  Did you notify the RN about holding the trazadone and seroquel?

I can completely understand why you held them, but it's still up to the doctor to decide if it's appropriate to hold them. 

I doubt that missing one dose of either meds is a problem. But almost all psychiatric mood altering meds, even when prescribed for sleep, cannot be stopped abruptly.

Yes, RN was notified. Resident was agitated this morning during AM care but not hs care this evening. More alert this evening than she was yesterday evening. 

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Glycerine82 has 3 years experience as a LPN and specializes in Subacute rehab, geriatric.

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I would have held the trazodone but never the seroquel without an order. 

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downsouthlaff has 9 years experience as a LPN and specializes in Nursing Home.

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It sounds like this woman may be over medicated and CMS has come out with new regulations to try to reduce the use of antipsychotics through GDR and monitoring programs. But you have to remember that as a nurse you can never hold a med without an MD order or a standing parameter. Nurses can not instruct other nurses to hold meds. We do not practice medidicne. Now the appropriate thing to do In that situation would have been to notify MD of the over sedation and try to get underlying problem addressed not just hold the med. That’s the hallmark of nursing. Good luck to you 

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downsouthlaff has 9 years experience as a LPN and specializes in Nursing Home.

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On 6/25/2019 at 5:24 PM, brownbook said:

Great, that explains a lot.  Your protocol is to notify the RN, (and document that you did).  Did you notify the RN about holding the trazadone and seroquel?

I can completely understand why you held them, but it's still up to the doctor to decide if it's appropriate to hold them. 

I doubt that missing one dose of either meds is a problem. But almost all psychiatric mood altering meds, even when prescribed for sleep, cannot be stopped abruptly.

But even though the RN was notified, unless there would be some kind of standing arrangement between RN and MD, an RN telling an LPN or another RN to hold a med without an order from an MD is still not permissible as nurses at any level other than APRNs cannot practice medicine. Deciding when to hold meds with no standing parameters is practicing medicine. 

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1 hour ago, downsouthlaff said:

But even though the RN was notified, unless there would be some kind of standing arrangement between RN and MD, an RN telling an LPN or another RN to hold a med without an order from an MD is still not permissible as nurses at any level other than APRNs cannot practice medicine. Deciding when to hold meds with no standing parameters is practicing medicine. 

I agree completely.... I mentioned in my previous replies that a doctor must be notified. It seems  that the protocol in this special care unit was the LPN notifies the RN. I told the LPN to document that the RN was notified. 

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