Patient asking for ativan hours in advance regularly, prn for anxiety.

[EarthwormRN]

I have this patient who asks for ativan every day at 7pm. I was told by my supervisor that I need to offer alternative ways to calm her down before giving her the ativan, such as offering food, water, one on one, back rub, visualization etc. Well this patient refuses to take part in the other methods and sternly says I wouldn't ask for it if I didn't need it. But at 5 oclock, she will say bring me an ativan at 7, and I think how does she know she will be anxious at 7 o'clock? The only time she doesn't end up getting the medication is if she doesn't ask for it, if she does, she bullies me until I cave and I cave pretty easy. I talked with a fellow nurse on a different shift about how "pain is what the patient says it is" but is anxiety what the patient says it is as well? I think yes, but i wonder what my supervisor thinks. How should I go about this situation?

[montecarlo64, ASN, BSN, LPN]

I am in Indiana and yes, this IS a state requirement here. Not just for one particular facility but for ALL skilled long term facilities. I suggest you read your policy regarding administering prn anti-anxiety/hypnotic and pain medications to see if this is true for your state.

[iluvivt, BSN, RN]

If the patient has an anxiety disorder and has been taking the medication for awhile she most certainly can know she needs it at 1900. She may have withdrawal symptoms. A family member of mine could not go without hers for even a day. She has switched to a different medication now but still needs anti anxiolytics daily daily. What is going on with the patient and what is her current mental state? If I was the resident I would ask my doctor to just order it q day at 1900 so I would not have to jump through all those hoops. Personally, I have found po Ativan to not be that effective but IV Ativan sure is!