psych med administration...help!

[sweetieann]

quick question....This is in regards to psych hospitals mostly...it is my understanding that if a patient has a standing PRN medication, say IM ativan for agitation, and they refuse it then you cannot administer it to them against their will. The doc has to write a one time order for the RN to administer it on the basis of emergent danger to self/ others. Now, let's say this patient is on an involuntary commitment. Can the medication THEN be given even if pt refuses? Or would a one time order still need to be written in this case?

Also, one more example. Say a pt comes in that is catatonic and unable to take PO med to help them out of this state. The nurse administers the med IM, as the pt is unable to open their mouth to swallow the pill form. IS this ok? The pt obviously can't consent because they are catatonic and not in touch with reality...so it is ok for the nurse to give the med IM in this case? (the dosage was written for as PO OR IM in order). Of note, the pt was brought in involuntarily (obviously they couldnt seek tx themselves if they werent even in touch with reality).

Thanks!

[elkpark]

(I responded to your other thread on this topic.)

In regard to the catatonic client, I would hope that the treating physician(s) would either get consent from next of kin or go through your state's legal process for forcing medication on people against their will.

If you've spent any amount of time working in psych, though, you know that many practitioners are happy to trample on or overlook people's legal rights for their own convenience ...

[Meriwhen, ASN, BSN, MSN, RN]

With regards to the involuntary commit: AFAIK the patient can still refuse medication unless they are court-ordered medications.

Mind you, their refusal of medications isn't going to help them when their case is reviewed...

[Jules A, MSN]

Maybe I misunderstood the question but if I have a patient that is a danger to self or others I do administer PRN IM medications against their will.

[safiyarozz]

To my Knowledge if one is committed involuntarily they still have the right to consent lest they have been proven incompetent or by court-order.

[Jules A, MSN]

To my Knowledge if one is committed involuntarily they still have the right to consent lest they have been proven incompetent or by court-order.

For standing orders yes and they are med paneled before we can force them to take medications but that is not how we do emergency IM PRN medications in the event of a violent outburst.

[safiyarozz]

For standing orders yes and they are med paneled before we can force them to take medications but that is not how we do emergency IM PRN medications in the event of a violent outburst.

That is when they are a danger to themselves or others only,correct?

[Jules A, MSN]

That is when they are a danger to themselves or others only,correct?

Yes if they are aggressive or self harming but not for things like severe disorganization or actively responding etc.

[elkpark]

Any client, voluntary or involuntary, can be medicated against her/his will in an emergency situation where s/he is an acute danger to self or others.

[Meriwhen, ASN, BSN, MSN, RN]

I asked one of our doctors about this...he wasn't sure

Granted, he's an addictionologist and most of his patients are both voluntary and non-psychotic...