Psych Nursing Question PO vs IM

[Roda dendron]

This is more of a legal question regarding when to give an IM vs a PO, with consideration of taking the least restrictive route of course. Say for instance, working on a psych floor a patient suddenly gets violent and grabs another patient and begins shaking them aggressively and at this point talking them down doesn't seem safe do you still have to legally offer a PO prior to calling security and providing an IM injection?

[JuanabePHNurse]

In this scenario, it's going to take that PO medication about an hour to kick in while it may take that IM about 15 minutes. If that person is unable to be talked down to be offered PO, then IM it is. Also, what happened before this incident? Was the nurse of the agitated patient aware of their potential to be aggressive? What was done? Was PO meds offered and refused? If PO was refused and this happened, then IM it is. IM administration can be very traumatic for both patients and staff. Communication with the patient is key to minimizing this. I always like to stay in constant communication with my patient and tell my patient an IM will help them calm down faster and document this in my  charting. 

[verene, MSN]

You would likely want to call security/additional staff for help separating patients, managing the rest of your milieu and creating a safer situation. Once separated it would depend on what happens next - can the patient deescalate and accept oral medications? Or are they going straight into restraints after punching security and trying to climb through the ceiling of the seclusion room?  

You always want to offer least restrictive means and it is NEVER to late to return to less restriction if the patient is able & willing to safely accept.  When doing something that takes away patient rights - be it restraint, seclusion, movement restriction, IM meds, etc - the important piece is to document rationale  - were less restrictive means offered and unsuccessful? Was the situation too unsafe to use less restrictive means? 

Particularly with  mental health law you want to be familiar with the laws of your specific state (or jurisdiction if you aren't in the U.S.) and your facility policies. 

 

[verene, MSN]

Edited post for clarity.