Hi, I work in case management and much of the population I manage are behavioral health members. Over time I have seen trends such as multiple ER and INP admissions of the same members, under a select few psychiatrists.
I must keep my personal family experience private but will share small details: a family member went thru three years of hell from being wrongly prescribed antipsychotics ..she was titrated up on one, discontinued and started on another, and we had no idea whether she was experiencing withdrawals from one or adverse reactions to the new med. Over a dozen pills and 7 ER admissions within six months later, she stopped all meds and is fighting to get her health back. She had switched to another psych who mentioned her nervous system had taken a beating and was a victim of polypharmacy ..and inaccurate assessment/diagnosis. He slowly safely weaned her off of everything.
I started noticing trends of multiple antipsychotics , high doses, mixed with multiple ER admissions. I've always been interested in working in pysch inpatient, but now I just don't know if I could pass out pills that I might question.
As a nurse have you ever approached a psych and suggested they are on too many, or maybe the wrong combinations of pills? I know it would be ballsy. I know when I worked in long term care the polypharmacy to the elderly made me leave the job.
What are your thoughts?
Feb 11, '13
Our residents aren't on a lot of meds. The bulk of it's supplements, to be honest.
...and it's not like no one has a say-so. If you question the med, contact the provider.
The hard thing about it, from my perspective? Finding the time to call...and educating the med aides to watch out for such things.
The med aides pass the scheduled meds+narcs. The nurses only handle prns. I don't see the med aide MAR.
We've lots of work to do. I sometimes have to be reminded 3-4 times by the aides to do a task...and I keep sticky notes (for my charts) AND a notepad on me. I have to jot things down because so many things will spring up at once.
I forget. The ADON catches order/med mistakes when reviewing the MARS and charts.
...but I do try to catch things at the ground level.
I heard it said that nurses have lots of responsibility and no power.
Not from my perspective. Nurses have a huge amt of responsibility but we've a lot of power, too. Or, at least, I think so.
I don't work with providers that ignore the nursing staff. Why would they when we see and interact with their pt's way more than them?
So, if we suggest that a resident might do better on a liquid form of depakote... or that 'this' person shows marked improvement since being on Clonopin + haldol (vs ativan) ...or that 'this' resident is screaming like crazy, experiencing an increase in delusions, etc.. and has been ever since they went to the hospital and had their depakote DC'd...or whatever the case? <-- which is precisely what's going on with one of my residents who is practically psychotic at this point. (I only know about it because I play med nurse on occasion and know what she does/not take.)
The provider is likely to listen. Even if it's to DC a med, they'll listen to you as long as you have sound reasoning.
If I see neg new developments that can be attributed to a certain med? I'll take it to the provider and they'll be glad that someone's keeping them abreast of change. They care about the pt's, too.
All in all, people need to understand that we're all in it for the same thing.
This is a team effort, here.
We're trying to help our people out. That's not doctoring. That's nursing.
We advocate. That's my job.