Quote from michelle126
Well, I don't have to worry much about this one since I work LTC. All orders must clearly specify the dosage to be give. Even a 1-2 percocet order needs clarified. 1 tab for moderate pain or 2 tabs for severe pain, etc. If we ever need to titrate a med we need to call docs. Leaves little room for nursing judgement.
Well maybe that's the difference for me, too.
I have never worked in an acute unit, like ICU, only worked in a hospital for a year after I got out of school at Long Beach Community Hospital, Long Beach California in 1974-75, and not even in an acute unit there.
I've worked mostly LTCs and where I work now is with the state of Arkansas, with the mentally challenged. We give aLOT of behaviourial meds, but we have psychologists available all the time, and we have a psychiatrist who visits regularly. They monitor and make med adjustments often. It is just not left up to the nurse to make any medication titrations. Only time any PRN adjustment would be if someone started behaving very inappropriately with aggressive and violent
behaviour. Even then other measures are used before chemical restraint is called upon. It has to be really bad before we go chemical. And the nurse does not make the descision.....
The RN on call, the superintendent, the doctor.....there are many people notified before we can even give an injection even if we have an order. It just isn't done here. They are so strict about PRN chemical restrtaints.
That's okay, because that takes that responsibility off of me. If any PRN is needed for behavior, there are plenty of others who will help make that determination for it to be given .
I remember one instance where one of our people became so violent, they had him restrained on a papoose board and he was still fighting and caused himself some injuries. They used chemical on him. The kid got mad because he wasn't allowed to go on a trip that some others went on. He was very spoiled by his family, and this had been building up for awhile. He had to be transferred to a unit where he could be monitored more closely.
Personally, I think it's better this way. I'd hate to know that a nurse gave me Haldol because I was moaning. Maybe it was pain and I needed something for pain, not Haldol.