IM meds question

[sassifras85]

Hi everyone!

I have a question regarding PRNs. Say a psych patient has an order prn ativan 1 mg PO/IM for severe anxiety. If said pt suddenly became an acute danger to self/others but refused this med PO, could this med be given IM to them (over their objection) due to the emergent situation? What I am getting at is, I know this would be ok if the PRN was written for 'agitation' but what if it was written for 'anxiety' as in the above example? Am I splitting hairs? My gut tells me thatyou would administer the med to protect patient/others in this scrnario, and I'm probably over thinking this, but just wanted opinions.

[TerpGal02, ASN]

We usually have to call for an IM as most pts are not admitted with prns. The only exceptions are when we are getting someone we know is violent or they have prns at home (and that's usually a benzo). They only pre order IMs in the former case.

[Mandychelle79, ASN, RN]

Seeing that severe anxiety can manifest as agitation I would give it. But I do try to talk all patients into the PO, not only for their safety and comfort, but I really hate to do the paper work if we have go hands on for the short amount of time it takes to administer.

[Meriwhen, ASN, BSN, MSN, RN]

At my first job, almost all of the doctors would order PO/IM PRNs with their admission orders. In fact, each doctor had their favorite set of PRN meds, so if Dr. X called with admission orders, we knew what PRNs to add on.

[x19amanda]

The MD that wrote the order should have not wrote it for "anxiety." It should've been written for restlessness and agitation, because who is to say that his person is experiencing anxiety? You would have to really prove that which may be hard when the patient is having extreme behavioral issues. If it's ordered prn for agitation and restlessness this can be proven that it was administered appropriately when documenting what S/sx were occurring. I hope that makes sense.

[MrChicagoRN, RN]

CMS would object to a PRN for anxiety being given for agitation but if that's all you had at the moment, you'd probably give it.

best practice would be something like "Lorazepam 2mg po/im q4 for anxiety/agitation".

[hiphopRN]

We can't have PRN IM meds pre-ordered here, unless there is just some physical reason why the person can't swallow the meds or something. We can have PO meds for anxiety or agitation but if the patient refuses them then we need to call the provider and get a one-time dose for an emergency injectable, and with that comes the order for the restraint we'll undoubtedly have to do to medicate them against their will.

We have had quite a few providers recently writing orders for PO or IM meds but management is putting the kibosh on that due to the fact that it could be construed that we have standing orders for involuntary E-meds, which is not allowed. Possibly that varies state-by-state since I'm the only one on the thread so far bringing it up, dunno!

Our facility recently went to this policy as well. When I first started we had standing PRN IMs to be given in emergency situations, but now we have to call during each emergency situation to get IMs. We are able to have the attending put IMs "on hold" so that we know what to recommend to the on call doctor if something happens, but we still have to call a doctor prior to administering any emergency IMs.

[JuliRN]

Our admitting orders allow us to list different po/im medications prn. We do have a few listed for agitation, but if we have someone tearing up the unit, threatening staff, harming self/others, I'm definitely on the phone with doctor getting something stronger that will cater exactly to that specific pt.'s needs.