Med overrides

Specialties Psychiatric


I'm a student doing my psych rotation. In our state, you can get a med override to give meds against a pt's will if 2 MDs agree. On the ward where I am it is always done via NGT. You call a code, 8 guys show up, you 5 point the pt. and shove an NG tube up their nose. Luckily, as students, we don't have to do this. I have enough trouble getting an NG tube down a pt. who agrees to it. I have watched though and there is blood everywhere. It is incredibly traumatic. Is this a common practice? I worked inpatient psych (some at the state mental hospital where we're doing our rotation) about 10 years ago and I don't remember NG tubes except for pt's who refused to eat. For med overrides, we tried po with a show of force, then IM meds. I asked my instructor and she said it was probably because a lot of newer psychotropics don't come IM. Well, what about a little Ativan then, wait 30 minutes, then try po again? What about IM Haldol or Geodon? There's gotta be a better way.


221 Posts

Holy Guacomole!

I work involuntary psych and we do not place NG tubes for this reason



1,041 Posts

Wow. This borders on barbaric to me. I'm shocked someone hasn't called the local dept of health and/or more serious injuries haven't occurred with the whole administration process. Sounds to me like your ideas are common sense. Wonder why the powers that be see the obvious as well?


53 Posts

Thanks for the feedback. I was appalled and am trying to get a handle on 1)how common this is nationwide 2)why they do it this way 3)what alternatives there are.

Right now (when I'm not a student) I work at a residential treatment center for DD adults. We have a lot of dually diagnosed folks (in this world that means DD/MI not MI/drugs or alcohol) and we do have folks that refuse meds. The only meds we give involuntarily are those which would be life threatening if not given. Around here that usually means seizure meds and insulin. And even for those we write a med administration plan with a hierarchy of steps. Most drugs we just wait.

jnette, ASN, EMT-I

4,388 Posts

Specializes in Hemodialysis, Home Health.

I'm having a VERY difficult time believing what I'm reading ! :eek:

This is unheard of !!! I am in total shock, dismay, and disgust. :(


221 Posts

so, I left for a while

thinking and thinking about this

coming back and verifying this is what I read

>> it is always done via NGT

is incredible.


53 Posts

I, too, thought about it for a while. You know, when you're uncomfortable with something and wondering whether it's okay, it probably isn't. Since everyone at this institution thinks it's okay and my clinical instructor doesn't seem to think it's out of line, I was thinking that maybe I was just a newbie and didn't understand some underlying compelling reason. Thanks for the reality check. I checked the state law that covers it and I guess it is legal although I'm pretty sure it's not what the legislature intended. Next time I'm at clinical, I'll check the institution policy manual. And I'll check with some people I know to see if this is institution wide or just this ward and this doc. And then I'll take a deep breath and make waves. Not what I want to do as a student but ethics are ethics. What do you all think my approach should be? Routes I have considered are: the state protection and advocacy association for mentally ill people; my clinical instructor and my SON advisor; whatever regulating agency oversees this place.


174 Posts

Specializes in Operating Room (and a bit of med/surg).

Wow! I'm glad I haven't encountered a situation like this! Does your placement have any sort of patient advocate? At my psych placement there's a patient advocate office that deals with pt's rights. I'm sure they'd be interested in what's going on!

Good luck!

~ mae

Specializes in ED staff.


haven't these folks ever heard of IM injections? someone call the civil liberties union.

sanakruz, ADN

735 Posts

IM meds from which to choose:








(more I'm probably forgetting....)


Haldol Dec

Prolixin Dec

.....and next month


I imagine this is being done with the good of the pt. in mind. But it seems too invasive with too many risks to give something via ngt.

I worked at a SNF where the pharmacist had compounded a paste of olanzapine and ativan which was absorbed through the skin. It worked great! The family of a confused and combative dementia pt paid for this. The pt. didnt try to remove the patch because of her cognitive deficits. My point is that there are many creative and kind ways to get someone to take their meds.If the person opens their mouth there's always Zydis,which dissolves under the tongue and works great. In CA a person must have something called a Reise hearing in which an administrative law judge decides a person is not making a rational decision by refusing meds. The pt is involved in this process and is thus prepared for an outcome.:rolleyes:

sanakruz, ADN

735 Posts

Imd 32 I'm going to guess this is Washington where this is happening- From what I've read the state mental health system has completely broken down- They place DD, Heroin addicts, suicidal folks and those with schizophrenia in one ward .Individuals more approriate for the criminal justice system are there also victimizing the helpless

Please tell me I'm mistaken.


221 Posts

sanakruz, you are on the mark


Imd, request help from your instructor in this

maybe you can get permission to investigate

code 8

incidence, rationale, outcome

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