To medicate or not to medicate

Nurses Medications

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So I generally work 3p-11p. I always scope out the PRN's to see if my patients like to take sleeping meds or anxiety before bed and always ask if they want them. I otherwise use my best judgement if I feel they need or don't need them. Basically I don't like to just give everything to get them to bed. It never fails though, as I am giving report to the next shift, I get chewed out for not giving all that is possible! I don't understand why you would just give everything possible...even if not needed. I like to always have something on hand if necessary and leave something available for the next nurse. I get told I should have already gave it or "wouldn't you rather them have a good-nights sleep?". I can recognize when someone needs it, I just don't like to over medicate. Am I wrong in this thinking?

Specializes in Behavioral Health.
I usually know what my patient usually takes and give it. I am not going to wait until 3 am to think " oh maybe I should have given them something."

It seems like there's probably a middle ground between "throw the kitchen sink at them," and "wait until they've missed half the night to intervene."

I would not let them refuse if it means they are going to awake and /or yelling/ climbing out of bed all night.

How about the Afib patient who refuses to take their anticoagulant or the patient with a bp of 200/110 who refuses their antihypertensives? Aren't they allowed to refuse either?

Patients have a right to make stupid decisions for themselves. Legally or ethically, we don't have a right to force-feed our patients their medications. Not even when we know that the patient would benefit from said medication.

Specializes in Acute Care, Rehab, Palliative.

How do you educate a demented patient that is eating the contents of their brief that they need to take something ?

Specializes in Behavioral Health.
How do you educate a demented patient that is eating the contents of their brief that they need to take something ?

It's possible to construct scenarios in which it's okay to give a patient medications without educating or asking them, but it seems like the OP was more general, and not specifically about patients who lack the capacity to make decisions.

How did this devolve into forcing demented patients to take benzos?

Take a step back and cool down, please, and come on back to Rational Land.

I think two things about the scenario the OP posted:

1) You are giving too much information in report. Why does day shift need to know you didn't give your patient a PRN? They don't. Tell them that it is available Q whatever hours for whatever indication and leave it at that. I agree with Dogen, if the patient needs it daily, day shift can address it with the provider and get it scheduled.

2) Make sure the patient is asleep by midnight or so. If they aren't, then they need it. Check to make sure they aren't/weren't a noc worker, though, that changes things. These patients sleep better in the afternoon.

If your patients are asleep by midnight-ish, you have done your job and you can tell day shift to worry about what happens during their shift and to leave you alone.

Specializes in Critical Care.
How do you educate a demented patient that is eating the contents of their brief that they need to take something ?

Maybe it's different in Canada, but in the US there is a legal process for medicating someone against their refusal, and just having dementia doesn't automatically allow us to medicate someone despite their refusal.

Specializes in Critical Care.

Everywhere that I've worked it's a general rule that evening shift does not give prn's for sleep, if you do you'll get chewed out by the night nurse who will usually demand that they be the ones to give the prn sleepers.

Specializes in LTC, med/surg, hospice.

If it's LTC, yeah I generally hope the prior nurse has given the meds for sleep. I don't mean to snow the patient but certainly if Ms. Beth has been getting 1/2 a xanax and a norco at HS for 5 years, please give it to her.

For acute care, it doesn't matter to me. If I offer the patient a med and they decline or say "I'll let you know if I need it", I've done what is necessary.

Specializes in SCRN.

PRNs are just that. If a nurse thinks a PRN is needed, then she gives it to deal with a current issue, not something that MIGHT happen at 4 AM. Why does the overnight have a problem with that? Get your PRNs started right at 2300! Problem solved. If a PM nurse gets blamed on overnights, why doesn't the AM nurse on PMs, and the overnight on AM's?

1) You are giving too much information in report. Why does day shift need to know you didn't give your patient a PRN? They don't. Tell them that it is available Q whatever hours for whatever indication and leave it at that. I agree with Dogen, if the patient needs it daily, day shift can address it with the provider and get it scheduled.

2) Make sure the patient is asleep by midnight or so. If they aren't, then they need it. Check to make sure they aren't/weren't a noc worker, though, that changes things. These patients sleep better in the afternoon.

If your patients are asleep by midnight-ish, you have done your job and you can tell day shift to worry about what happens during their shift and to leave you alone.

The OP works 3-11p if I understood correctly. These are the night nurses coming on who are questioning whether she/he gave the prn meds.

If it's LTC, yeah I generally hope the prior nurse has given the meds for sleep. I don't mean to snow the patient but certainly if Ms. Beth has been getting 1/2 a xanax and a norco at HS for 5 years, please give it to her.

If she's been taking a Xanax and Norco every night at HS for 5 years, then nursing ought to have spoken with the physician about making those meds scheduled for that time.

Specializes in General Internal Medicine, ICU.
Maybe it's different in Canada, but in the US there is a legal process for medicating someone against their refusal, and just having dementia doesn't automatically allow us to medicate someone despite their refusal.

It's the same in Canada. We can not and do not medicate someone if they clearly refuse. There is a legal process for that.

...as for the discussion, patients have the right to refuse medications, tests and procedures. We can only educate them, and in some cases, encourage them to go through with some things. But if the patients refuse, then we can not force them to do anything against their refusal. Patients are allowed to make stupid decisions, provided that they have been educated.

PRN meds are ordered on a "as needed" basis. You do not give PRN meds if your patients do not need them! The shift coming on at 2300 is able to give all the PRNs to knock the patient out if they want.

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