Overmedicating...NO!!

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

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.

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.

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.

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.

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.

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

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.

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.

Seriously?

Nurses are administering doses of medication without medical order, without standing orders, or without a specific protocol giving them permission and authority?

wow