Lying about a med to a psych patient

[cel58]

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.

[VictoriaGayle]

You can medicate someone against her/his will, without her/his consent, over her/his objections, in an emergency situation where the individual is acutely dangerous to self or others. However, in nearly 30 years in psych, I've never lied to a client about a medication I was giving, and can't imagine doing so.

I don't think you could even argue that the patient was dangerous, since they had apparently calmed them down already (though to what extent we can't be sure) and since they were able to get consent when they thought they were going to give patient X, I don't see why you would have to lie when you got Y instead, unless the patient was agitate again or demanding X and refusing Y.

I've been to a psych ward as a patient. It's sad how some of the nurses look at you like you aren't even human, just a problem they don't want to deal with. Don't get me wrong, there are some amazing psych nurses out there! But in any specialty, theres always a few bad apples. I'm not saying you should never use restraints, or give meds with out consent, just don't think that just because someone is in a psych ward that its ok to treat them poorly.

My big question for OP is : what was the reason for the lie? Was patient becoming agitated/dangerous again? Was there reason to believe he would only take ativan? Or did the person administering the medicine just not feel like explaining what they were going to give them and getting consent again?

[marydc]

I've been a psychiatric nurse for 24 years and have been involved in many crisis situations requiring emergency medications. I also speak as the voice of one who was assaulted and seriously injured by a psychotic patient. We state the facts and do what is necessary for the safety of the patient and others. Those burdened with a mental illness deserve honesty and respect just like any other patient. I don't see how there can ever be any moral justification for lying to a patient.

[sauconyrunner]

Part of the problem here may be that the patient was becoming more and more agitated and was not medicated until he began throwing things.

The patient possibly could have been medicated with ativan long before the table throwing started. Case in point. I came in one day and was working in the Psych holding. There was a woman who was standing at the door, staring in a menacing way. The night shift RN told me, oh yeah, she has been standing now and pacing and staring for about 2 hours... About 30 minutes later, she assaulted the CNA who was trying to bring her breakfast. When did that woman need medication? oh about 30 minutes after she started pacing. It was not recognied...and thus she escalated and a very dangerous situation occurred.

The other option which does not always work with psych pts because they are usually well informed on meds...is to ask them: Can I give you a medicine to help you calm down some? Never name the medication....thus you aren't lying. But of course...that does not always work...

[Malanya]

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.

As long as the way the chronic psych patient is wanting to avoid "feeling" is the extreme pain of EPSE, your first reaction would be legit IMHO. While I've never been combative in an ER, a situation did arise where I was given Haldol, and developed severe EPSE. I have never been in that much muscular pain in my life, and it wasn't confined to just one muscle group.

Really, given that less potent neuroleptics are less likely to cause EPSE and NMS, I don't understand why haloperidol and droperidol are still so commonly used. It might be a bigger shot to use Thorazine, but if your combative is screaming "No Haldol", there might be a reason that's more than just that they don't like how it "feels"....and if you aren't sure why they're rejecting one particular one, go for one that has a slightly less intense side effect profile JIC.