Overmedicating...NO!!

ProgressiveActivist, BSN, RN · Dec 9, 2015

Dont cosign the ativan waste and say no you can explain this to the pharmacy.

allnurses Guide · Dec 9, 2015

I'm a little frightented by some of my colleagues actions...most epecially with psych patients. I see nurses giving more anti psychotics than ordered. One night my pt was seizing..doc ordered 1mg Iv ativan... med contained 2mg.. Nurse says fÃ—Ã— it Im giving 2!!! I said no were not and drew it up myself... Another pt to recieve 2.5 of Haldol nurse gives 5 bc "its not touching her"... That time I wasnt there..I find this dangerous and wrong.. As a nurse if med not helping another call to doc is due..Yes its annoying but Im not at liberty to practice medicine... Future nurses this is Not good practice and you could lose your license... Dont do it..3 years in and still learning..

I worked psych for a number of years and the practice in our facility was to ask if we could repeat the dose if the first one was not effective within the expected time frame. I was a big fan of the 5/2/50 cocktail which pretty much put even the baddest actor on their butt, but I would never do it without a physicians order.

Something to note especially with the person having a seizure is that some times dual diagnosis patients fake seizures to get high.

Hppy

Editorial Team / Admin · Dec 9, 2015

Have you reported this to your supervisor? Having knowledge of this practice and not reporting it makes you just as guilty as the perpetrators. Management needs to address this- not only is it unethical and practicing medicine without an order, it's a disservice to the patients as they are not getting adequate medications ordered but the medications may be thought to be therapeutic based on how the patient is responding to the additional undocumented dosage.

Been there,done that, ASN, RN · Dec 9, 2015

I would not administer the entire vial of a scheduled drug.

With Haldol , when a wimpy intern orders one milligram, I had no problem administering the 5 mg milligram vial, if I knew that is what it would take.

Whatever get's ya through the night.

Lev, MSN, RN, NP · Dec 9, 2015

I would not administer the entire vial of a scheduled drug.
With Haldol , when a wimpy intern orders one milligram, I had no problem administering the 5 mg milligram vial, if I knew that is what it would take.
Whatever get's ya through the night.

And what happens if your patient goes into torsades that night? Would you speak up and tell everybody that you gave 5mg instead of 1mg of haldol?

I have undermedicated (4mg morphine ordered. Patient's BP borderline. I gave 2mg with the intent of giving the 2nd half of the dose if BP stabilized somewhat and patient requested more pain medication) but I will never never give more than an ordered dose without getting an order. Not taking that liability risk.

Been there,done that, ASN, RN · Dec 9, 2015

And what happens if your patient goes into torsades that night? Would you speak up and tell everybody that you gave 5mg instead of 1mg of haldol?
I have undermedicated (4mg morphine ordered. Patient's BP borderline. I gave 2mg with the intent of giving the 2nd half of the dose if BP stabilized somewhat and patient requested more pain medication) but I will never never give more than an ordered dose without getting an order. Not taking that liability risk.

As it it oral Haldol that can lead to Torsades, no. At least the patient would have left their telemetry on.

Isitpossible, LPN, LVN · Dec 9, 2015

Rose Queen..No I did not report. I was not on the unit of the RN who gave that Haldol.. It was second hand information. Of the ativan no need to report I simply did it myself and pt got correct dose. As one can see from been There done that...it seems to be common practice with psych pts especially. I will not report on something I have not witnessed first hand.

CryssyD · Dec 9, 2015

You're right to be concerned--the stuff you're describing is very bad practice indeed, and will result in serious consequences if the Board ever finds out. It's never OK to give more medication than ordered--what do they plan to do if and when an adverse reaction occurs? How do they plan to explain why the patient's medication is effective when they give it but ineffective when others give it?

If I were you, I would take this up the chain of command--it's bad news and could result in patient harm.

ProgressiveActivist, BSN, RN · Dec 9, 2015

IV haldol most certainly can prolong the QT and put the patient at risk of Torsades.

Dranger · Dec 9, 2015

As someone who sees psych drug ODs on the daily, a few mg of Haldol is not going to drastically increase the QT interval and there are many worse drugs that prolong it.

Working in a craphole I see my share of drug addicts and alcoholics. Have I seen nurses give an extra mg of Ativan? Sure. Is it right? Maybe. If they are on the CIWA protocol, you can just increase the score which makes the Ativan increase okay per protocol.

Sometimes nurses give an "ICU" dose aka the whole vial in situations like the OP described. Is it best practice? No Is it legal? No. Does it work? Sometimes. Is there patient consequences? Never that I have seen.

I am not one to do it or to have seen it, but I have heard people talk about it.

ProgressiveActivist, BSN, RN · Dec 9, 2015

Agree that many drugs that prolong the QT. I have seen torsades in an alcoholic who received IV haldol.

I have seen a frail woman go into respiratory arrest from 0.5 mg of lorazepam po. I would never exceed the prescribed amount even if I have to page a doctor twenty times to sedate a patient.

In psych the maintenance dose is based on the amount needed for a psychiatric emergency.

So called Nurse doses are bad practice.