There was a patient who came in and was on the alcohol withdrawal protocol, with symptom triggered PRN ativan ordered. He wasn't on a scheduled taper. No hx of seizures or anything. He was more or less scoring high enough on with withdrawal scale to get the PRN because of anxiety and some agitation (not because of sweating, tremors, etc). He decided to sign a 72 hour notice to sign himself out after being there a day or so. On the morning he ultimately ended up getting discharged (the RNS didn't know he would be getting discharged this day because the Dr. hadn't come in to round yet), he got a PRn Ativan for "withdrawal" (with his anxiety/agitation prompting the score to be high enough to trigger for a PRN ativan). He was a very anxious guy in general. He received this about 8am. When the Dr came in a few hours later, he talked to the patient and said he was going to discharge him. I mentioned to the Dr that the patient had received a PRN Ativan earlier that day, but the Dr was ok with discharging him. At the time he actually left the unit (a few hours after receiving the 8am ativan), he wasn't anxious, his vitals were fine, etc.
My question is, was it legitimate of the dr to discharge him despite the fact that he got a PRn for 'withdrawal' earlier that same day? The RNS do tend to be somewhat liberal with the PRN Ativan for withdrawal because the patients can be so anxious and agitated as they are giving up their substance of choice (alcohol). But I don't know if the Ativan would have been given if it was known he was getting discharged that day. Even though the pt didn't have tremors, visual disturbances, etc from withdrawal and mainly just had anxiety that allowed him to score high enough for the Ativan, I just wasn't sure if there could be an issue with the Dr. discharging this patient and if any liability could come on the nurse if there were any issues.
I work in inpatient psych not detox but I deal with patients who are on CIWAs and Opiate withdrawal protocol quite a lot. In my facility patients are technically not supposed to receive PRNs close to being discharged, therefore, if a patient asked me for Ativan and I know they will be getting discharged the next day I don't dispense it and I explain to the patient that if I do it may cancel their discharge. When I have patients on CIWAs/Opiate protocol they are usually there for enough days that the Valium or Ativan are discontinued by the time they are discharged. I guess it depends on the facility and what you are actually treating but if you are ever in the above situation just make sure you document really well > why the PRN was warranted and what the physician stated, etc. so that as an RN you are covered in case anything uncanny happened after the patient was discharged.
Specializes in Leadership, Psych, HomeCare, Amb. Care.
Before I came aboard, it was an unwritten rule to not given PRN prior to DC, "because it shows they aren't ready for DC." I didn't see the logic. Many patients experience DC anxiety. Driving themselves home is extremely rare, and most are prescribed a prn for wherever they are going, so why not send them out on the best possible level?
last thing I want is for the patient to arrive at the group home, NH, 1/2way house in a bad frame of mind because of anxiety possibly exacerbated by a socially inept medicare driver or EMT.
Give them what they need to get them where they need to go, and on a good level.
For the straight detox pts on my unit, a 72 hour notice doesn't even apply. Detox is treated more like a medical admission. They can sign themselves out whenever and they usually do (if they are going to sign out AMA) when they are in the middle of detox receiving prns. If they are that hot to leave the hospital there is no question about the adverse effects of being sent home in acute withdrawal because I guarantee you they won't be in acute withdrawal anymore by the time they get home. They resume drinking/drugging the same day. That will definitely alleviate withdrawal symptoms.
EatYourVeggies
81 Posts
I work in inpatient psych not detox but I deal with patients who are on CIWAs and Opiate withdrawal protocol quite a lot. In my facility patients are technically not supposed to receive PRNs close to being discharged, therefore, if a patient asked me for Ativan and I know they will be getting discharged the next day I don't dispense it and I explain to the patient that if I do it may cancel their discharge. When I have patients on CIWAs/Opiate protocol they are usually there for enough days that the Valium or Ativan are discontinued by the time they are discharged. I guess it depends on the facility and what you are actually treating but if you are ever in the above situation just make sure you document really well > why the PRN was warranted and what the physician stated, etc. so that as an RN you are covered in case anything uncanny happened after the patient was discharged.