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Old 07-01-2007, 05:37 PM
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Default PRN Haldol

I believe in the power of Haldol. It is an inexpensive drug that works, however, I'm seeing more docs shy away from PRN Haldol, and other meds, because they are "chemical restraints." I want to give people medication if the need it, but my hands are tied. The patients don't get better, and the nursing staff is left at risk of being hurt by violent patients. I'm tired of this trend. Are you seeing the same trends at your hospital?

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Old 07-02-2007, 08:35 AM
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Post PRN Haldol...........Let's try Geodon

Fortunately, I am not seeing the trend to reduce "chemical restraints" in the department in which I work; but then again, I work the ER and sometimes it's either chemical, physical or both kinds of restraints that are needed to keep everyone safe, including other patients.

You might find it amusing, but some of our patients come into the ER asking to be restrained because they can feel themselves getting out of control. They don't want to hurt anyone, and they certainly don't want to know they have hurt anyone after the fact. Yes, those patients are few and far between; but they should tell us something.......that chemical restraint is necessary in some situations.

Now, to all of you out there who think we are talking about "snowing" our patients, I can assure you, I am not. I'm just talking about getting them "in control" so when the medication kicks in, the law of reasoning is once again instilled (somewhat) in these patients.

Don't forget, mental illness is a DISEASE. Would you withhold Nitroglycerin to a heart attack? It's the same thing. Get what is out of control in control and let's deal with the disease process.

Sorry, I didn't realize I carried my soap box with me this morning.
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Old 07-02-2007, 11:07 AM
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I wish you would come to my hospital and give my boss and our new doc an inservice about medications. The nurses on our unit have been warned about the "over use of PRNs" and our doc is grossly under medicating patients. I'm afraid that someone is going to get hurt on our unit because of his stupidity.
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Old 07-02-2007, 05:22 PM
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We detoxed a woman recently. Ativan drip at over 20mg PER HOUR. And she was still fighting against the restraints and required Haldol. Fortunately the doc came in during one of her freak outs (did I mention? 20 MILLIGRAMS of Ativan per HOUR?? IV!!) and upped the frequency of the Haldol we were giving her.

MJ, that doctor you're working with sounds dangerous. How does he get away with that? Can you talk to the medical director of your unit?
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Old 07-02-2007, 08:47 PM
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The doctor gets his way because he is from and rich and powerful family of doctors who work at our hospital. My boss is not supportive. In fact, she took away my weekend alternative shifts for questioning the doctor's judgment and his behavior. She wrote me up and put me on day shift so I can be "retrained."

Yes, I'm looking for a new job.
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Old 07-02-2007, 11:14 PM
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I will never understand that kind of nonsense.
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Old 07-03-2007, 05:58 AM
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When I worked on a locked child/adolescent unit, we had a "coctail" of haldol and cogentin, IM. It was the prn of choice for the doc and the nurses. The cogentin was added because teenage boys are prone to EPS. I loved that combo!

B.
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Old 07-03-2007, 05:25 PM
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Haldol and Cogentin are a great combo-platter. Better living through chemistry
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Old 07-04-2007, 02:47 PM
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Default Haldol

It's interesting to watch the waxing and waning of drugs-of-choice. It seems that haldol is continually coming in and out of favor. There's always concerns with older adults, but hey "benzos bad." (even w/the short half-life of ativan, it can still accumulate and then there's those ever-popular paradoxical effects). What I find is that for haldol to be effective (at least for things like delirium) it needs to be given regularly. A single PRN dose isn't going to make a lot of difference. But get it going 'round the clock and it can help a lot.

But that's just my experience.
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Old 07-04-2007, 04:42 PM
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It is so true! Medications are the greatest invention one minute and then a big no-no the next minute! I've seen one dose of Haldol work in the ER, but then no one is ever there long enough to need a second dose from us!
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