View Full Version : PRN Haldol


Mother Jones, RN
07-01-2007, 06:37 PM
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?

MJ

MyOwnWoman
07-02-2007, 09:35 AM
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.

Mother Jones, RN
07-02-2007, 12:07 PM
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. :mad:

geenaRN
07-02-2007, 06:22 PM
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?

Mother Jones, RN
07-02-2007, 09:47 PM
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."

:mad:Yes, I'm looking for a new job.

geenaRN
07-03-2007, 12:14 AM
I will never understand that kind of nonsense.

Nurse Stella
07-03-2007, 06:58 AM
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.

Mother Jones, RN
07-03-2007, 06:25 PM
Haldol and Cogentin are a great combo-platter. Better living through chemistry :D

Marachne
07-04-2007, 03:47 PM
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.

KimRN
07-04-2007, 05:42 PM
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!

KimRN
07-04-2007, 05:48 PM
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.

You make a fantastic point!!! Mental illness is a disease! And the more we talk about it the less stigma is attached.

It is also devastating to those who suffer from it. I have a niece who has been diagnosed with Borderline Personality Disorder and that is one of the hardest to get a handle on.

But we talk about it, discuss it - and we have to remember there is a person, someone's daughter, wife, mother, niece under that diagnosis. Sometimes it is hard to do.

I just realized I used only female examples up there. My only experiences wit BPD, either professionally or personally have been with females!

Ah, move over on the soapbox - there is room for all! :)

Judy Pelfrey
07-05-2007, 03:57 PM
Hi Mother Jones and all, I've worked in a state psych facility for 26 years. 22 years on the units and the last 3.5 in QM. We used to use the Haldol/Cogentin cocktail til IM Geodon arrived. Now I see a lot of Geodon/Ativan being used. The only problem I've seen is the limitations on number of doses of IM Geodon being allowed. Sometimes our patients receive the 2 they are allowed in 24 hours then it's back to the Haldol. While not all of our patients go this route, there are enough who are sufficently aggressive to be in restraints for up to 12 hours while the care staff struggle to find the right medicine combination to allow them out again.
BTW I'm in QM now due to patient injuries that resulted in an impaired shoulder and no more direct patient care allowed. I'm all for using meds and restraints as needed, even if the party line is to reduce use of all restraints. The reduction would come if we could train our attendants to interact with patients appropriately, not needle them into rage, or fight with them over who's in control, or remind them of their limitations. Where are the nurses? Trying to take care of all the 'other stuff' they have to do.
Oh, there is that soap box again.

Mother Jones, RN
07-05-2007, 04:23 PM
Oh Judy, your go Sista! You're right. We need to free nurses of the tons of paperwork, so we can--do I dare say this--take care of the patients. Sorry about your injury. I've also had some very bad injuries in my day, too. The people who make the rules about not restraining patients make those rules because they DON’T work with patients. Let them get seriously injured, and I bet the rules would start changing in a heartbeat.

MJ

Judy Pelfrey
07-05-2007, 04:49 PM
You are so right Mother Jones! Those who make these rules are not 'out there'. The guiltiest of those people are The Joint Commission. Every year rules change and we have come up with yet another piece of paper to show that we complied.
One of our nurses recently complained that she has to fill out 15 pieces of paper to admit a patient. Some of the info collected is collected on more than one piece of paper. So yours truely will be taking that list of redundancies to the Policy Committee to see if there can't be some changes made. (My body may not be able to do patient care, but my heart will always be there.)
So while not on the lines I still try to represent the lines. I see nursing being eaten up by paper and often wonder if I would be a nurse again. Yep, it's all I ever wanted to do. Well except when I was 4 and thought I'd like to be a ballerina. Then my Gramma convinced me I didn't want that, as I would have to practice all the time and would get headaches! Gee Gramma did you think nursing was easier? (Now that she's in Heaven I hope she's learned The Truth.)