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Immediately medicate patients around the clock or redirect?

Psychiatric   (724 Views | 7 Replies)

The0Walrus has 1 years experience as a ASN, RN and specializes in Psych.

1 Follower; 1,986 Profile Views; 105 Posts

I work in an inpatient psych unit. I try to redirect my patients who are not violent. This includes patients who the other nurses tell me to simply medicate with the morning meds and to medicate around the clock. So far many times I have been able to redirect my patients.

One nurse told me to medicate a patient because she got naked the day before and was manic. Throughout my shift if she became upset it was because I was too busy to get her to use the phone to call a family member. Another patient can get close to another female patient so the nurse started medicating the patient. When I had him I was able to redirect him by talking to him and the girl.

Should I just be medicating these patients when I get in and just keep them medicated for my entire shift or should I just keep redirecting them? Many of them are just a nuisance but are redirectable so I don't want to just be medicating them. There's a part of me that feels it's a form of chemical restraint especially since I can redirect them. Thank you!

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The0Walrus has 1 years experience as a ASN, RN and specializes in Psych.

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Just wanted to add that there was a hospital that would medicate their patients at night with Benadryl to keep the patients sleeping. The unit nurses got in trouble. I can understand why. I saw it as a chemical restraint as well.

Here is the article:

https://abc7ny.com/5609185

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123 Posts; 2,681 Profile Views

It depends on the situation. If a patient is starting to get agitated and they have a history of violence, I usually try to medicate early before there is an emergency. You wouldn’t withhold pain meds from someone who just had surgery or antibiotics from someone who has pneumonia. In some cases, the patient really needs the medication to stay safe. If other nurses are suggesting that you medicate your patients more maybe they are onto something? Have you been a psych nurse for awhile? If you haven’t, it is good to listen to those who have. 

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The0Walrus has 1 years experience as a ASN, RN and specializes in Psych.

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If they have a history of violence then I definitely medicate. If I feel I can redirect I do that.

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amoLucia specializes in LTC.

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Am reading this a bit late -

Perhaps the pt is redirect-able for OP BECAUSE the previous nurse medicated him/her. Perhaps WITHOUT that previous med the pt would be more likely to be exhibiting difficult behaviors.

Like no temp because pt had Tylenol 2 hours ago?

How does the pt act AFTER your shift?

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mariav has 7 years experience as a BSN, RN and specializes in Psychiatric/Mental Health, Substance Use Disorders.

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Trust your own nursing judgement. I'm assuming this situation is in regards to PRN medication as opposed to scheduled.  Only you can decide if a patient's presentation warrants the use of a PRN medication. Some of the PRNs we give to psych patients can have dangerous side effects that call for serious consideration.  If I were in your situation, I would look at the patient's history and the information passed on during shift change and make an informed decision in the best interest of my patient. If redirecting works for you and your patient, by all means continue doing it. 

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armygirlabn has 12 years experience as a ASN, BSN, CNA, LPN, RN and specializes in Med/Surg/Tele/ER/PICC/Psychiatric nurse.

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I work as a psych nurse on the day shift. Our facility provides PRN meds (most of the time they are given to patients) to help patients sleep during the night in order for them to be awake during the day so they can attend groups. If not, patients will be pacing and disruptive during the night and not allow other patients to sleep. These same patients then want to sleep all day and stay in bed and not attend any groups. Then doctors complain to the nurses to get patients out of their room. I don't believe the article is for nurses to have less work. Patients have to sleep so they can participate in scheduled activities. There is plenty of administrative stuff that night nurses have to get done. 

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Safety Coach RN has 7 years experience and specializes in Behavioral Health.

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On 2/25/2020 at 8:08 PM, The0Walrus said:

I work in an inpatient psych unit. I try to redirect my patients who are not violent. This includes patients who the other nurses tell me to simply medicate with the morning meds and to medicate around the clock. So far many times I have been able to redirect my patients.

One nurse told me to medicate a patient because she got naked the day before and was manic. Throughout my shift if she became upset it was because I was too busy to get her to use the phone to call a family member. Another patient can get close to another female patient so the nurse started medicating the patient. When I had him I was able to redirect him by talking to him and the girl.

Should I just be medicating these patients when I get in and just keep them medicated for my entire shift or should I just keep redirecting them? Many of them are just a nuisance but are redirectable so I don't want to just be medicating them. There's a part of me that feels it's a form of chemical restraint especially since I can redirect them. Thank you!

Medicate using your best judgement to keep yourself and patient safe. I take note of others reports and requests on patients but ultimately I'm not  medicating unless I can justify that medication on my shift. 

Now, I'm all about being proactive instead of reactive too. That  just  takes experience knowing when medication is appropriate. If the patient is  redirecting though, that's not justification for a PRN. 

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