Tips for administering Haldol

Whispera, MSN, RN · Mar 27, 2011

Have you had the situation of a patient running and charging at staff? I never have, in spite of lots of years working several places. Are you anticipating possibilities? Do you have an isolation room for out-of-control patients?

I can't imagine running after a patient who is charging other staff members. It seems to me staff would get out of that patient's way, and get the other patients out of his or her way too, until the rage passes. Meanwhile, police would be called and any security system the facility has would be activated.

A charging patient is dangerous to you as you try to inject him or her, if not restrained by other staff first.

That being said, sometimes we get the injection into the body any way we can. The risk of a patient being a danger to others outweighs the risk of hurting him with the injection.

Did you mean you might inject the wrong person, in the chaos of the moment, by missing the patient and injecting another staff person?

I think we need more information about what you're thinking.

atypical_psych_rpn · Mar 28, 2011

"on my particular unit we are not allowed to use restraints and it has less resources (no padded room) "

isn’t the haldol a form a restraint? (chemical?)

also i would never recommend injecting anybody moving around and trying to run away from you, this is a very unsafe practice.

at my facility, all staff who respond to an aggressive/ unmanageable patient are trained in nonviolent crisis intervention. we also do not use padded room, but have access to a seclusion room which is basically an empty room with a special mattress in it.

what we do, using verbal intervention we try to convince the patient to walk with us to the seclusion room where he can take time to "take the edge off" this does not always work. when a patient "charges" which has happened a few times in the past we try to remove all patients and staff from immediate danger and try to isolate the responsive patient as much as possible. once all the non physical intervention are used without success we use a nonviolent physical intervention. this normally allows us the opportunity to transfer the patient to a safer location where we can hold him in a control position to safely administer the chemical restraint. we then try to keep the patient in seclusion until reassessed by the psychiatrist.

we always try our best to keep the situation from getting physical, and always try several times with a po prn before administering the im. from my experience prevention is key and proper assessment of a patients mental status is key in keeping yourself and your patient safe. more often then none we take care of the situation before it become unmanageable and physical.

we also barely use haldol, there are much safer newer drug options now available.

hope this helps...

mentalhealthRN · Mar 29, 2011

I can't imagine not having restraints when you really need them. And I personally have always likes haldol. Old yes, but it works. Geodon I see not working as well or taking too long to work, Zyprexa okay, better, but then you have limits with your benzo....Abilify IM-um not great either. So I have always been a fan of good old haldol myself. And as far as being concerned that you might stick someone besides the pt--like someone else helping to restrain the pt--I have always found communication works best. Making sure you tell them to let you know when they are ready and feel the pt is as still and secure as they can get him/her. Then let them know where you are going and if you are in a place near someone else-- say so--"I am right by your backside Mike--don't move backwards" -- then say-loud enough for all to hear- "all clear-med in" when you are done and the needle is retracted. Thats how we alway did it if we had to give a med while staff were restraining --and we needed to medicate before we got the pt into restraints. It worked.

WendyBensonRN · Mar 31, 2011

For a physically aggressive patient, we activate the Code Team, and all staff are trained in NVCPI. We always do least restrictive means first, so with that being said, here is what we do:

1. Verbally redirect the patient to take a personal time out or come talk to staff.

2. Administer PRN medications as ordered. This may mean using a hands on approach.

3. Seclude the patient.

4. Mechanically restrain the patient if the patient is attempting to harm himself/herself in the seclusion room.

We try really hard to follow that protocol, however when a patient is physically aggressive and will not verbally redirect under any circumstances, we go straight to leathers to prevent injury to self, copatients and staff.

NurseSuzann · Apr 16, 2011

Thank you for your feedback. I've since learned a lot about giving Haldol IM in an aggressive patient and also learned that my staff are great at restraining for this act but that sometimes it is not always ideal and I have even had to give it through clothing because it was just not possible to get their shirt or sweater off.

Usually we will have a plan. First we get all the other patients and visitors beyond the doors of the particular section then we try verbal redirecting, then PO PRN, which will work if it hasn't gotten that bad but if its gotten bad enough that I have to re-section off the unit I know I pretty much have to go for the haldol. Then we will decide who will approach from what side and what arm/leg and what side I will approach for the needle, Needle in then we let go and get out of the way while making sure all the rest of our unit is safe.