Hi - something came up this week with a hospice patient who is home and her caregiver and I'm not comfortable with it.
Our patient is getting more agitated and combative. Her diagnosis is CHF and co-morbidities include diabetes with right leg pain due to insufficient circulation. She's on anti-psych meds and anti-anxiety meds - dosages just increased a few days ago. Long-time caregiver (prior to hospice) sometimes has to deal with hours of agitation and hasn't called us.
We've dealt with that - encouraging her to call. We also have a new order for Haldol 4 mg IM for agitation that doesn't respond to her cocktail of meds. The nurse has given one dose so far and it worked well. Now the powers-that-be think we should teach the caregiver to give an IM of Haldol prn.
I'm uncomfortable with this for 3 reasons. One - Nurse Practice Act:
A health facility licensed pursuant to subdivision (a), (b), or (f), of Section 1250 of the Health and Safety Code shall not assign unlicensed personnel to perform nursing functions in lieu of a registered nurse and may not allow unlicensed personnel to perform functions under the direct clinical supervision of a registered nurse that require a substantial amount of scientific knowledge and technical skills, including, but not limited to, any of the following
1) Administration of medication.
(2) Venipuncture or intravenous therapy.
(3) Parenteral or tube feedings.
(4) Invasive procedures including inserting nasogastric tubes, inserting catheters, or tracheal suctioning.
(5) Assessment of patient condition.
(6) Educating patients and their families concerning the patient's health care problems, including postdischarge care.
(7) Moderate complexity laboratory tests
Two: Can you imagine a layperson doing an assessment to decide about giving prn Haldol and then giving an IM injection to a combative and agitated elderly women? Is this even fair to the CG? Or the patient.
Three: Um - isn't this what hospice nurses are for??
So, I'm asking for advice here.
Have any of you taught a caregiver to give an IM injection of a drug such as Haldol? Do you think it is against the Nurse Practice Act? Do you think it would be unfair to do this to the CG or patient? Do you think this is the nurse's job?
Specializes in BNAT instructor, ICU, Hospice,triage.
We stopped using the cream because it's expensive to compound. And my agency is all about the census and bonuses.
I hate the gel. We use it and you may as well put on water as the gel.. I feel that it doesn't do a thing for people. I prefer rectal ABHR. Can you get haldol suppositories?
Specializes in LTC,Hospice/palliative care,acute care.
Have you considered involving other agencies? Is this client really in a safe environment? I think your "spidey" senses are telling you she needs additional support and the caregiver is overwhelmed. In my area the office of aging can step in and assess the situation quickly. They may or may not take action but at least you'll know another professional without conflicting interests is involved. By that I mean the hospice agency-NOT you personally.
No, we would never do this. We would send in a nurse to give the injection, however we probably would not use IM haloperidol anyway. There are so many other options available. Sublingual haloperidol (2mg/mL) works quite well. There are also topical applications that can help with agitation (although we don't use those much either). Subcutaneous injections are pretty easy to teach, but IM injections require more training and I for one am not comfortable with this. Another reality is that a paid caregiver is bound by state law, and generally the state nursing practice act would not allow an untrained paid caregiver to give an IM injection. I think you're asking for a lot of trouble to save a couple of bucks. Not a good idea.
Vtachy1
448 Posts
I hate the gel. We use it and you may as well put on water as the gel.. I feel that it doesn't do a thing for people. I prefer rectal ABHR. Can you get haldol suppositories?