Post your Ideas

Dear Fellow Collaegues-
Now my question to you is, Don't you think its silly for nurses to ask for a doctors order for Ativan just to get a patient to be quiet and pass out. Just so that their neighbor can sleep? I understand the logistics but the point is shouldn't you use your judgment to figure out why that patient is up and what you can do to relieve the patient's stress rather then chemically restraining them? Its just begins a vicious cycle of agitation when they come off of it.
Yah, that's pretty silly. If it were for true anxiety or agitation that couldn't be resolved w/o more organic means, then I'd say ask for the ativan.

It's not only silly it's unethical.

Oh yeah...it is unethical alright. Why don't we just give our kids some Benadryl too when they are hyper so we can have a good night's sleep? Seems ridiculous, because it IS. You are right on the money, Tyvin.

If Ativan is ordered PRN then nurses are free to use good judgment. Of course I use a lot of Ativan, Fentanyl and Versed in the ICU when patients are intubated. Sedation while intubated is a kind thing.

I haven't come across that scenario, and yes it is unethical. I wouldn't want to be the nurse who calls a doctor to order something based on the complaining of someone who isn't their patient. The doctor must have a reason to prescribe a medication and anything other than "give Ativan prn my patient annoys his roommate" would be dishonest. The better strategy may be to call the other guy's doctor for a sedative order. The chemical restraints used on the pt who is noisy probably wouldn't benefit from non-pharmaceutical stress relieving activities as he is not bothered by the noise he makes and the other person is.In general, though -- a sleep aid can be used to balance the unfamiliar surroundings and general noise of hospitals. It's used for a short period of time - generally stopped when the patient is discharged and hasn't used the drug long enough to cause withdrawal effects.

chemical restraints are still a restraint and should meet all the standards for initiation. One standard is the MD is NOT to order prn med for restraint purpose. Assess the pt and maybe include a blood sugar fingerstick during the night (when agitated). Low glucose levels have been associated with this behavior. Maybe all they need is some juice and crackers and a trip to the potty.

Of course sitting and talking to a patient to see if there is anyway to help the patient calm without meds is always a good thing and definately giving a med the patient hasn't indicated needing because of the roommates request is wrong. However I must say that if the patient has made the request and is stating feeling anxious that it does make me crazy to hear nurses say to the patient--you just need to do some deep breathing and try to relax. You're fine. --Anyone who has ever had issues with anxiety knows that this doesn't work. All you are going to have is a set of well oxygenated lungs! lol When a person actually suffers from anxiety they need medications to calm them. It is a true illness of the brain and a person can't "just calm down". To me this is asking a person to do something that is just totally out of their control. Same as you can't tell someone who is clinically depressed to "just cheer up" or someone with true anorexia to "just eat". So in the case of the OPs question: If the patient states needing help with meds to calm down enough to sleep--give them the meds. Sometimes its anxiety with more of the SOB and inner restlessness (akesthesia) and it can be more of a mania too--they can't stop to constant racing thoughts enough to sleep. If the person is just annoying staff and or their neighbor--talk to the person and let them know that the others are having trouble sleeping due to his/her noise/moving around the room/etc. and you need to have him/her get some sleep or at least rest and ask what you can do to help the patient do that.

I detest Ativan at the best of times; thank goodness the Drs at my hospital never prescribe it!I've seen the lingering confusion this stuff can cause, and I'd look for better alternatives, starting with something like hot chocolate or better still, cocoa, and a trip to the toilet.In my almost-forgotten youth I worked in a psych facility. If patients were restless at night and were reasonably oriented we'd have them sit up and chat for a while. Much better than encouraging chemical dependency.

When I was a student, we had a very elderly, VERY demented lady whom we could not get a private room for. So she was put in a 4 bed ward. Every night she NEVER slept, not one iota the night nurses said & all the other patients were getting sicker and complaining. I mean this old woman was the worse I have seen, and she would always start up about 9 pm with her high-pitched wailing, and God knows what else. I was so glad I didn't have to do night shift then.The night nurses told us in handover they tried soothing her, talking to her, doing back rubs, put on the overhead light in case she was afraid of the dark, whatever they could think of, but they had to get meds ordered to knock her out & even that didn't work very well according to them & all the other patients. Then the other patients were grumpy and sullen the next day cos they were kept up night after night.I don't know what hell this woman was re-living but she was fine during the day, quiet & mostly compliant. I think meds are underused for these patients. And when it is affecting other people, and there's nowhere else u can put them, medicating them is a reasonable action. This is what these meds are for. All the nursing homes I've worked in, they sedate their patients for the night, otherwise some wander & even try to attack other patients in their beds. Let's face it, demented patients aren't going to get any better are they? So u may as well give them and everyone else a good night's sleep. And it isn't illegal to do this. If I was the other patient I would be taking something, or asking if the patient could be given something to calm them a little.