To medicate or not to medicate

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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 Acute Care, Rehab, Palliative.

We do 12 hour nights and our meds are at 2100. We don't duscuss the PRNs with the patients because they are confused. We just give what they need to settle.

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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.

Whoops. That's a whole different ballgame.

In that case, I guess it's up to you, OP. If you feel they are unnecessary the noc shift can re-address it if the situation changes. But medicating someone with benzos for the convenience of staff is an illegal form of chemical restraint in the U.S.

Let me repeat those three important words - illegal chemical restraint. That's what you can tell the oncoming shift if they give you grief.

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Specializes in PACU, pre/postoperative, ortho.

Personally, coming in at 2300, I prefer if there is still a PRN available (not always possible I know). If eve shift has thrown everything at them, I then have to go in at wake them up for my assessment & pray that they will be able to go back to sleep easily. They often do go back to sleep, but not always & it's nice to have a little backup. Do these night shift nurses not bother to do assessments in order to avoid waking the pt?

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Specializes in Acute Care, Rehab, Palliative.

I don't wake them up for asessments. I either do it in the morning or chart that the patient is sleeping. Once our folks are settled we don't wake them up for anything.

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Specializes in Behavioral Health.
I don't wake them up for asessments. I either do it in the morning or chart that the patient is sleeping. Once our folks are settled we don't wake them up for anything.

That would be awesome, but it sounds like maybe you work LTC, because that doesn't sound like something we could ever do. Well, psych assessments you can put off, but not physical.

When I was in medical we were supposed to do an assessment at med pass, and chart it within the first two hours of the shift (and possibly again later in the shift, depending on the assessment type). Not that it always happened that way, but that was the goal. There was no option to not assess, say, cap refill on a femur fx with external fixation, or neuro assessment on a stroke patient.

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Specializes in Acute Care, Rehab, Palliative.

No not LTC. Hospital. But not critically ill patients.

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Wow! I did not expect this kind of response! It is awesome though, thanks everyone for your input! I will say I was only working3p-7p this day. This pt had ativan available as a PRN. It had not been given and I just gave the schedule Geodon. Pt was not anxious and was quite pleasant for me during these 4 hours that I was there. Did not show any sign of agitation. Oncoming shift was upset that I had not given it yet. I did not see the need for it, I just told oncoming that it was there if needed. What bothers me is that some oncoming people think I should give everything PRN for them but I do not feel that it is right or necessary. If they want it or need it, I give it. I do not withhold anything from them! I recognize my bias towards some medications but I would never not give or go against an order because of that.

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Specializes in Psych ICU, addictions.

If you didn't see any clinical need for a PRN, then you were right in not giving it and night shift just has to deal with it.

That being said, when it comes to PRN sleep aids: you may want to start offering such medication come HS. If they refuse, then fine, they refuse. But that also doesn't mean you can't say to them at 2245, "hey, I'm on my way out the door, do you want your Ambien (whatever) before I go?"

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Specializes in Acute Care, Rehab, Palliative.

Well yeah if you are leaving at 7p you don't need to worry about hs PRNs at that point.

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Specializes in Psych, Addictions, SOL (Student of Life).

Hi you don't say if you work in an acute setting of LTC but from your hours I would hazard to guess it is LTC. I work the same shift and this is my take on the whole bedtime/PRN/Routine meds angle.

Many of our residents have been with us a long time (4 years or more) we know them well and know their patterns. If they have a routine sleep med ordered and they have been taking it for years I give it. After-all it's routine order and has been asked for by the patient and their family and ordered by the doctor. In California Sleep medication is considered a psychotropic and therefor a chemical restraint. An informed consent must be signed by the patient or POA before it can be prescribed and it's need has to be periodically reviewed by all parties involved.

I have even had patients refuse their Routine sleep meds - if that happens more than three times in a row I will call the physician to see if he/she wants to change something.

If the order is PRN and I am passing bedtime meds ( 9:00 pm) and the resident is wide awake I will ask them if they would like their sleeping pill with their other meds. Sometimes they say yes and sometimes no. They often have pain and anxiety meds as well and you'd be surprised how many nurses will cocktail up a whole bucket of PRN meds at bedtime. Which often leaves the patient so obtunded it's hard to tell if they are asleep or in a coma.

Some of my residents take a prodigious amount of narcotics and anti anxiety medications which in my humble opinion makes for a higher risk for falls and injury.

I don't medicate my patients to make their care more convenient myself or the shift that follows me. I asses my patients and pass the meds accordingly by what the physician has ordered.

Hppy

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Specializes in Psych, Addictions, SOL (Student of Life).
Wow! I did not expect this kind of response! It is awesome though, thanks everyone for your input! I will say I was only working3p-7p this day. This pt had ativan available as a PRN. It had not been given and I just gave the schedule Geodon. Pt was not anxious and was quite pleasant for me during these 4 hours that I was there. Did not show any sign of agitation. Oncoming shift was upset that I had not given it yet. I did not see the need for it, I just told oncoming that it was there if needed. What bothers me is that some oncoming people think I should give everything PRN for them but I do not feel that it is right or necessary. If they want it or need it, I give it. I do not withhold anything from them! I recognize my bias towards some medications but I would never not give or go against an order because of that.

Just a side note from a crusty old psych nurse - you should always give Geodon with a light snack as it requires a certain digestive enzyme to activate and be fully effective. I got this from a Geodon Rep years ago when I went to a seminar and asked why the Geodon we were giving didn't work well.

Hppy

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Just a side note from a crusty old psych nurse - you should always give Geodon with a light snack as it requires a certain digestive enzyme to activate and be fully effective. I got this from a Geodon Rep years ago when I went to a seminar and asked why the Geodon we were giving didn't work well.

Hppy

Thanks for that! Luckily he had just ate supper. I don't have much experience with Geodon. Before I was a nurse I worked in group home with DD adults. I noticed then that alot of those folks had reactions to Geodon. Do you have any thoughts as to why that population would have so many reactions? Nobody at the time could answer that for me and I completely forgot about until now.

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