Recent change in nationwide regulations regarding IM?

[Nope]

Hello allnurses!

Recently, the facility I work at has changed it's policy regarding medicating

Patients against their will. We used to, with the permission of immediate family/the court,

Give medications to someone who has no capacity to make informed decisions for themselves. This could be due to acute psychosis, severe mania, etc.

Now however, we cannot medicate against the wishes of the patient unless it is an emergency.

I was told that this change is one going into effect at hospitals nationwide.

So I am curious,

Has anyone else encountered a recent change in how patients are medicated on your units?

[Davey Do]

So I am curious, Has anyone else encountered a recent change in how patients are medicated on your units?

In a nutshell, this is the procedure on giving medications against the Patient's wishes:

We may give forced medications in the event that a Patient is a threat of harm. In order to administer these so-called forced medications, the RN has to obtain an order from the Doctor, as PRN meds are unacceptable. A packet which includes several forms is completed. If the Patient is combative, a "Code Green" is issued for Staff support in administering the injection. Any type of "hands on" intervention is considered a restraint and another part of the packet is completed. The packet is generally for seclusion/chemical/physical restraint(s).

A Physician may order Emergency Forced Medsictions without needing through the Court, for example, overt psychotic symptoms. These Orders are good for 24 hours. If need be, new orders are generated every 24 hours. For a variety of reasons, the Patient often becomes treatment compliant after 2 to 3 days.

Then, there is the process of Court Ordered Medications. The Patient and a Treatment Team appear before a Judge and a verdict is rendered, usually in favor of the Treatment Team. An Order is issued for specific medication(s) with a dosage range and length of time these meds will be administered. Again, the Patient usually becomes treatment compliant after a few days and willingly accepts the med without incident.

The Emergency Forced Medication 24 hour procedure is the newest way of administering medications to a treatment non-compliant Patient. It's been around since 2007, so there haven't been any recent changes.

[Whispera, MSN, RN]

Where I've worked, we didn't medicate against patients' wishes unless there was a threat to self, others, or property. The threat could be verbal, or escalation of behavior. The medication had to be specifically ordered and outside the prns already ordered. That doesn't mean it wasn't given before the order was obtained, but the order was obtained ASAP after the crisis was calmed. Nurses had a teamwork relationship with the psychiatrists, and psychiatrists listened to nurses' concerns. There wasn't ever a time a psychiatrist refused to order the medication.

There was no such thing as a court order to force medications in any patient, no matter the symptoms or legal status of hospitalization. Even patients on detention had the right to refuse medications except in the threat or actual harm situation.