Benzo free inpatient hospital?

Specialties Psychiatric

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Specializes in psychiatric nursing.

I work as a RN charge nurse at a small 16 bed county managed acute inpatient psychiatric facility. The psychiatrist says she "doesn't believe in benzos" and has declared us a benzo free facility.

She won't prescribe them, no matter how agitated or violent the patient is. She refuses to prescribe benzos for patients who come in after long term ETOH use because she said "we are not a detox facility".

When a patient arrives who has been taking benzos prescribed by an outside provider, she will taper them off in a matter or 1-2 days, no matter how long they have been taking them.

I know that the prescription of benzos must be done with caution, but this psychiatrist's prescribing behavior is dangerous in my opinion and not beneficial for patients in an acute psychiatric crisis.

Does anyone else work at a benzo free facility?

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Specializes in Psych ICU, addictions.

I do not work in such a place. And while I'm not a big fan of benzos I do acknowledge their medical and/or psychiatric necessity...

To be honest, your facility sounds frightening.

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Specializes in psychiatric nursing.

It is frightening Meriwhen! None of the nurses agree with the psychiatrist's policy. This psychiatrist has a PA and a NP she oversees, and she FORBIDS them to prescribe benzos. In fact anything they want to prescribe, they MUST call the psychiatrist first so she can approve. She has made them change orders on more than one occasion. And the PA and NP have been working in psych for many years, so it's not like they don't know what they are doing.

Besides her questionable prescribing habits, she is a rude person and will chastise any nurse or anyone else on the treatment team that doesn't agree with her.

I took this job because it was closer to my house, I was already working at a much larger, better managed psych facility, so I know how things *should* work.

This place has a problem keeping employees (surprise) and we have not had a DON since the day that our private company took it over from the county in January 2015. (The private company now manages it in conjunction with the county).

The administrator just lets the psychiatrist do what she wants and treat employees as rudely as she wants.

It's a mess.

One of our RNs was severely beaten last week by a patient. This was a patient we all knew was escalating. He was prescribed a low dose of Zyprexa, and we could tell that was not helping him. The psychiatrist refused to change the plan for him...and now one of our nurses got hurt.

Needless to say, I'm looking for another job.

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Specializes in Family Nurse Practitioner.

It sounds like you have issue with her personality in addition to her prescribing so it sounds like a decent idea to find another job and possibly consider mentioning your complaints when you resign. If your PA and NP are bothered by this I would hope they will say something to change it or get another job. I have never worked at a place where anyone told me what to prescribe or I had to ask permission before writing an order but then again I have always made it a point to work with providers who had a similar prescribing philosophy to my own.

On both of the inpatient psych units where I work we are rather stingy with benzodiazepines especially for people with addictions issues however I am generous with them for the person who presents in alcohol withdrawal for obvious reasons. With regard to those who come in on them from an outside provider it is a case by case basis and yes we will also do a fairly brief taper for people who have either been abusing them or are using illicit substances especially alcohol. I do it in a safe manner and make no apologies for it. I personally think the unofficial extremely conservative recommendations for tapering benzos that are found online were clearly written by someone who was attempting to work over their prescriber to keep the gravy train rolling as long as possible.

Exactly how small of a dose of Zyprexa? Was there anything else available to go with it like Benadryl or Vistaril? Although I'm a huge fan of a B52 IM when needed I think there are some units where psych RNs rely too heavily on benzodiazepines prn when an antipsychotic with benadryl would be more effective for agitation especially if there is psychosis involved.

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This is a trend in psych, not just with benzodiazepines but medications in general. Providers are paranoid about prescribing appropriate doses and it's a shame.

For a provider to refuse to prescribe/order a benzodiazepine for inpatients is ludicrous. I knew a provider who was extremely reluctant to order them in a crisis setting, but I found out later that this provider had once abused them. Even then, they ordered Ativan for CIWAs and certain patients (e.g. agitation).

Personal commentary aside, it's time to find a new job. Benzodiazepines have a perfectly legitimate role in psychiatry and especially ETOH W/D. What is this facility/doc gonna do when they have seizures? I really question some of these "educated" professionals.

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JulesA, no offense but a good number of benzo users have been on them for years. Given the lipophillic nature and conformational changes in the CNS, I don't believe short tapers are always the best. I've seen plenty of short tapers and they appeared to work, but how long was their use? Often it's months not years. Plenty of legitimate journals recommend a protracted taper for these people. You have to consider relapse rate IMO.

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Specializes in Psych (25 years), Medical (15 years).

There were some Administrators at a Facility that encouraged the Psychiatrists not to Prescribe Benzos.

The Docs started Prescribing PRN Chloropromazine. Even to the Adolescents.

The Facility went back to its Old Ways.

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Specializes in Family Nurse Practitioner.
JulesA, no offense but a good number of benzo users have been on them for years. Given the lipophillic nature and conformational changes in the CNS, I don't believe short tapers are always the best. I've seen plenty of short tapers and they appeared to work, but how long was their use? Often it's months not years. Plenty of legitimate journals recommend a protracted taper for these people. You have to consider relapse rate IMO.

No offense taken I enjoy reading different takes on practice. As I mentioned the acute unit tapers are usually patients who are abusing them or someone who is unsafe with them. I'd agree 100% that brief tapers aren't ideal and I rarely do them outpatient but again as in the OP on an inpatient unit I absolutely will not send someone out with a benzodiazepine prescription if I can safely taper them down on my unit when benzodiazepines are clearly contraindicated as is in many cases.

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Specializes in Forensic Psych.

I don't work in a benzo-free facility, per se, but very, very few of my patients receive them outside of an ETO. Their reasoning is a bit more straight-forward. I work in a forensic facility where all the patients come from jail and all will be returning to jail - and there are no benzos in jail. I can somewhat understand the logic there and I can say a good number of the patients (but not all) are managed pretty effectively without. But in some cases I feel like a joke throwing Atarax at someone who's had to depend on Klonopin to be low-functioning at best for the past twenty years.

I honestly can't imagine NEVER using Ativan in a cocktail. Sometimes it's the only thing that stands between a patient and constant violence. I love when providers make decisions like that...because they don't have to deal with the consequences.

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Specializes in Family Nurse Practitioner.

I honestly can't imagine NEVER using Ativan in a cocktail. Sometimes it's the only thing that stands between a patient and constant violence. I love when providers make decisions like that...because they don't have to deal with the consequences.

Ativan in the cocktail is not the only thing standing between a patient and constant violence. Your comment about providers making "decisions like that" is uncalled for. Providers are are making "decisions like that" because they are licensed to do it and to suggest they don't order your choice of a medication because they don't have to deal with the consequences is out of line.

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Specializes in Forensic Psych.
Ativan in the cocktail is not the only thing standing between a patient and constant violence. Your comment about providers making "decisions like that" is uncalled for. Providers are are making "decisions like that" because they are licensed to do it and to suggest they don't order your choice of a medication because they don't have to deal with the consequences is out of line.

It's not out of line. It's my opinion, which I'm entitled to. Out of line is "monitoring" people's freedom to express such opinions on a public message board.

But I suppose you're entitled to your opinion about my opinion.

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Specializes in Family Nurse Practitioner.
It's not out of line. It's my opinion, which I'm entitled to. Out of line is "monitoring" people's freedom to express such opinions on a public message board.

But I suppose you're entitled to your opinion about my opinion.

You are absolutely entitled to your opinion. I had no intention or any ability to "monitoring" your opinion on this board. I just think your comments are generalizing and rude but again you are absolutely entitled to your opinion. I wish you all the best if as you have written you actually continue into the provider role yourself.

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