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.
I tried to call Washington State Protection and Advocacy Service but got stuck in voicemail. So, I sent them an email. It said:
I am a student nurse, currently doing a mental health
rotation at Western State Hospital. I am appalled by
the procedure used to implement med overrides. I
understand that, in Washington state, the right of a
patient to refuse psychoactive medication can be
overridden on the strength of an evaluation by 2 MD's.
However, the method used to administer these
medications is barbaric and abusive. On the ward
where I worked last Wednesday, I observed a woman
overpowered by a group of MHTs, placed in 5 point
restraints, and an NG tube shoved up her nose against
her will. The placement of the NG was not successful,
and considerable bleeding resulted. The nurse then
inserted the tube in the other nostril which was
successful, but the patient pulled the NG tube out
before medications could be given. IM Ativan was then
given and the patient took the oral medications 30
minutes later after she was calm. On this ward, 5
point restraints and an NG tube is the standard order
for administering refused medications. I question why
there is not a protocol with a hierarchy of less
restrictive and intrusive interventions and why,
specifically, IM medications are not used.
If I can be of any help to you in investigating this
procedure, please contact me. Also contact me and
advise me if there is some state agency I should
report this too.
I have not heard back from them. I checked with some of the other students and, apparently, most patients are cooperative with the procedure if it is presented to them as inevitable. I just happened to see a particularly bad example. I still think it's needlessly intrusive. I also question the wisdom of exposing student nurses to this type of mental "health" environment. I can assure you, no one in my class wants to work as a psychiatric nurse. And I know that inpatient, long term, chronic state hospital patients are not the only psychiatric patients in the world.
I don't feel my instructor is supportive. As I have mentioned before, she has been very defensive of the staff and I feel I am getting a reputation as a trouble maker. I do need to pass clinicals. Maureen- what's a code 8?
athomas91
1,093 Posts
i agree - im to calm then try po if needed - no reason for this roughness...