Jump to content

To drink or not to drink

Posted
ArmyMomJo ArmyMomJo (New) New

At clinicals this last week, an alcoholic was admitted and made to go cold turkey. It seemed to me that giving him a drink would have taken the edge off instead of putting him into DT's and making his life completely miserable. This is his 6th time in the hospital for over drinking and his liver is pretty much gone. Probably won't make it in again. What do you think of a physician writing for an alcoholic beverage?

NurseStephRN

Specializes in Telemetry, IMCU, s/p Open Heart surgery. Has 3 years experience.

I see physicians writing that order every once in a while. I have no problem with it. They aren't writing the order so we could have hapy hour with the pt... lol... the order is written to keep te pt from going into DT.

FLArn

Specializes in Hospice, LTC, Rehab, Home Health. Has 20 years experience.

Detox is not my area of expertise and I'm sure someone working in that specialty will add better information than I would have, but as a daughter and wife of recovering alcoholics let me say that often AA's will take a "bottle" with them when they take someone to detox. This is to prevent the person from going into DT's in an uncontrolled environment because most people have been trying to "cold turkey it" for a long enough time that they could start DT's before reaching the detox. Once there the MD usually starts a specific regimen of meds (they used to use Librium and a IV of vitamins "banana bag" among other things). These meds are much better (and safer) to prevent DT's in the hospital setting than continuing to give alcohol.

There were protocols in place for alcoholics in DT's were I worked, as detoxing from alcohol can be fatal. Usually pt's are given ativan and if necessary anti-seizure drugs or anti-psychotics . If his liver is barely functioning then more ETOH is not the best road to go down, the goal of his stay should be a safe medical detox. The poster above me brings up a good point, most people I've cared for come in with DT's because they've tried to stop on their own.

So our protocol looked like this CIWA scored q2 hours, banana bag q day for 3 days, vitals were q4, ativan was given based on CIWA scoring, occasionally we gave haldol per our protocol. There were parameters for vital signs and actions to take at certain times, so if they were too tachy EKG etc...

If you ask you preceptor maybe they can given you an idea of what the protocol is?

Thanks for the heads up. I am still a nursing student and it just made sense to not try to kill them before they could get better.

EmergencyNrse

Specializes in Emergency Medicine. Has 17 years experience.

I was once in the VA and we actually had beer in the med room.

Dr's routinely ordered it and it would be on their MAR.

generic-beer.JPG

Treatment for alcohol isn't WITH alcohol. It will totally depend on the focus of treatment & care.

Is the pt. there for detox? You meet his nutritional needs and cover the effects of withdrawal

with Ativan or Librium. Get them stabilized and begin rehab.

Sounds like you're dealing with a recurring drunk/alcoholic and the reality is they're probably

going to drink themselves to death. They will not stop unless they really want to...

Nothing you do or say, nothing the family, nothing loved ones can do will change them.

HAS to come from the patient.

holy cow... Ive never heard of this or seen this. When you get an order for this where do you get the alcohol from? It's not like pharmacy has a fully stocked bar full of brandy, wiskey, vodka? or do they? hehe

SlightlyMental_RN

Specializes in chemical dependency detox/psych.

This is why there exists CIWA protocols. There are much more less medically harmful ways to prevent DTs than to give an alcoholic alcohol, especially someone with impaired liver function. Additionally, this is why units such as mine are around.

KeeperMom

Specializes in ED. Has 10 years experience.

I'm also a student but I work as a tech on a med-surg floor and every now and then we get an alcoholic on the floor with an order for 2 beers a day or something like that.

Our pharmacy DOES stock it for such an occasion and it is usually a Natty Light. Most often, the docs prescribe Ativan or other med. I guess if an alcoholic really wants a beer or other alcoholic drink he/she can get a friend to bring one up so there really isn't a sure fire way to prevent them from drinking.

Interesting discussion!!!

m

flyingchange

Specializes in MPH Student Fall/14, Emergency, Research. Has 2+ years experience.

One of my clinicals I had a pt in with a laundry list of bad news. She was the sweetest old woman with a terrible prognosis. Her MAR had "1 glass Port, PRN". It was brought in by friends since she had no family.

nursynurseRN

Specializes in TELEMETRY. Has 12 years experience.

I work in a truama hospital and the trauma docs do it all the time... They either give them beer/liquor or librium.... But it does help one with each meal to an alcoholic does nothing to them... they say where not here to cure the alcoholism but their injuries.... makes sense since we are not a detox center.

Scrubby

Specializes in Operating Room Nursing. Has 6 years experience.

I saw an order for beer once when I worked as an AIN in oncology. I thought the doctor put it there as a joke or something but the RN's told me it was legitimate...

My Father was in a VA hospital in Kentucky during the late 1960's where it was (or so he swears) not uncommon for wounded soldiers to become addicted to morphine. He said a lot of the time they would cut back on the morphine and give the patients a shot (glass) of 80 proof alcohol for moderate pain relief. The rationale he was told is that it is easier to ween someone off alcohol then morphine. My father who later in life became an alcoholic greatly disputes this assumption.

himilayaneyes

Specializes in Critical Care/Coronary Care Unit,.

I've heard of situations where a physician may order 1 beer tid, but more than likely the doc is going to put the pt on librium while they're in the hospital and give an order for ativan prn.

NYnurseatheart

Specializes in Peds, Tele, ICU, ER, Orthopedics, Psych,.

I have worked in a hospital where they actually hung alcohol drips (I think it was 5% alcohol or 10%, not exactly sure) on patients who had surgery who were alcoholics. If their liver function was okay (perhaps not the best, but not in failure either) we essentially weaned it - it started out at 100 ml/hr, then every 4 hours we weaned it down by 10 ml. Usually by the time they were weaned off the alcohol, they were transfered from the ICU to a floor where a doc would order oral alcohol, rather than IV. The doctor's rationale was usually that this is what the patient is used to, and why take them off the alcohol and put them on Ativan or some other Benzo?

sunnycalifRN

Has 6 years experience.

holy cow... Ive never heard of this or seen this. When you get an order for this where do you get the alcohol from? It's not like pharmacy has a fully stocked bar full of brandy, wiskey, vodka? or do they? hehe

Oh yes, our pharmacy has beer and whiskey. Not prescribed too often, but I've given it.

GooeyRN, ASN, RN

Specializes in Psych, Med/Surg, LTC. Has 12 years experience.

I have seen orders written that a pt may have a beer or drink. Some patients do not want to detox.

LouisVRN, RN

Specializes in Med/Surg.

I can see that if a patient is there for a reason other than alcoholism this would be okay. However if the pt has substantial liver disease caused by alcoholism I do not see how the doctor could not be charged with maleficence should the pt/family later try to sue.