Lying about a med to a psych patient

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I'm interning in the emergency department right now. We recently had a schizophrenic patient come in and then had a major breakdown, becoming very violent and throwing tables at staff members. He eventually agreed to take IM ativan to help him calm down but the doctor ordered haldol and the nurse then lied and gave it to the patient saying it was ativan. I was just wondering is this illegal? While it was medically necessary for both the patient and the staff I was unsure whether or not it was ok to do.

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If the pt understood enough to consent to IM ativan, he should have been told about the haldol. I don't know the 100% legal answer. I'm looking forward to other responses from psych nurses perhaps who have dealt with violent pts.

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Specializes in ER/ICU/STICU.

I think it would be in the patient's best interest to do it that way. If he is that volatile and violent, then getting him the meds to calm him down is better than the alternative should he decide to go berserk about not getting ativan. Then a bunch of people would have to wrestle him and tie him down, where he would get much more than haldol and ativan.

Another option would be to talk to the doc about giving him some ativan as well.

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Specializes in Pedi.

If a patient is throwing tables, I don't think you need their consent to give them IM Haldol, as they're an obvious danger to staff and other patients. I've given IM Haldol and Geodon to combative patients (some of whom we had to call security to hold down just so we could give it) and have never once said "is it ok if I give you this shot in your leg?"

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Specializes in LTC and School Health.

I always say" This is something to calm you down" and give it. There isn't enough time to have a long discussion about it. Keep it short, simple and to the point.

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Specializes in LTC.

He's throwing tables at you.

Worry about his feelings later.

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Specializes in Acute Care, Rehab, Palliative.

Nope if we have a patient being violent there is no discussion about the shot.We just give whatever the doctor has ordered.

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Specializes in Critical Care.

It's one of those things that we do all the time and we could certainly argue that it's for the best, but it is illegal. Even violent patient brought in by law enforcement can refuse treatment. If the patient is an involuntary psych admit or has been declared incompetent by 2 MD's then we don't need their consent, but otherwise giving a med without consent is legally considered assault.

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Specializes in Med Surg - Renal.
If the patient is an involuntary psych admit or has been declared incompetent by 2 MD's then we don't need their consent, but otherwise giving a med without consent is legally considered assault.

Getting kicked, punched, bitten, scratched, and having furniture thrown at you is legally considered assault too.

So instead of both the nurses and the patient calling police and lawyers to file assault and battery charges against everyone involved, why don't we just give the patient some Haldol?

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

Many chronic psych patients KNOW their drugs and will refuse psych meds because they don't like the way they make them "feel". In the interest of everyone, even though you aren't "supposed to", a little white lie doesn't hurt when someone is psychotic in an Emergency Room. MunoRN is essentially right but I have always considered it part of implied consent. This is one of those time that the "school way" is completely different from the "real way". Heck years ago we gave placebos to our seekers ALL the time. We kept carpujets of NACl in the fridge to make it cold so it would sting and call it "Norasol" you know Demerol, Norasol......:o, and it worked!

Update: I have thought about this, in this case senario.......If I got the patient to calm down for the Ativan and the MD changed the order......I would not lie. A deal is a deal.

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Specializes in ER.

He is going to know it wasn't Ativan. So what are you going to do tomorrow when he knows you're a liar, and he's paranoid to begin with? Tell the doc to give his own Haldol. I'd give a whopping dose of Ativan. You can inject other meds later when he's easier to talk to. If you have to hold him down, do it, but don't lie to the man.

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When push comes to shove (literally) we're going to do what we have to do.

When you have a violent, hallucinating, delusional and adrenaline-driven patient with NO boundaries coming after you, you're going to take that patient down one way or another.

It may take six people piled on top and a needle to get it done.

We're not going to ask permission to do anything.

Oh, sure, if you want to try it, but it could be the last thing you do.

The same applies to non-violent crisis intervention.

If I am truly in a position where it is life or death for me... screw not hurting the patient.

I'm getting away any way I can.

I'll deal with the consequences later.

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