ED Nurses Agitation

[hopefulscribe2]

Hi there,

I am currently admitted for medicine and am running into an issue with ED nurses always calling about agitation to get prn meds like Haldol/zyprexa. For example, there would be a pt coming in for AMS, waiting for a bed on the floor, but the pt would be somewhat loud but hyper fixated about leaving. However, the agitation is re-directable but still wants to leave. Nurses would continually call about "pt is trying to leave" "pt called an uber" "pt is agitated" but everytime I visit him, like 4-5x, he would be sitting down or laying down, just somewhat loud but not violent or demonstrating major motor agitation. I even saw a nurse/tech outside the door shouting at the pt to shut up. Do you just give in to the nurses asking for prns?

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[EthylMethylMan]

I only ever sedate patients who are involuntarily admitted/unable to make decisions about leaving, and even then it’s generally only when they’re violent or a threat to self. Knocking a patient out is risky. It’s not wise to do it just because of nursing preferences.

 

[RangerBob]

Hi there,

I am currently admitted for medicine and am running into an issue with ED nurses always calling about agitation to get prn meds like Haldol/zyprexa. For example, there would be a pt coming in for AMS, waiting for a bed on the floor, but the pt would be somewhat loud but hyper fixated about leaving. However, the agitation is re-directable but still wants to leave. Nurses would continually call about "pt is trying to leave" "pt called an uber" "pt is agitated" but everytime I visit him, like 4-5x, he would be sitting down or laying down, just somewhat loud but not violent or demonstrating major motor agitation. I even saw a nurse/tech outside the door shouting at the pt to shut up. Do you just give in to the nurses asking for prns?

I often tell the RN to leave the patient alone. Most agitated patients do just fine if we don't bother them.

Sometimes they just need something to do/someone to talk to. On rehab we have a few CNAs that can act as sitters. If the patient is independent enough we'll let the CNA walk them around the unit/hospital. Probably not applicable for a patient in the ED since they're on the acute side of things still... But the sitter could chat with them, play a game, whatever. Just beware that sometimes that person in the room in of itself causes agitation, getting back to my #1 advice--leave the patient alone.

If they're truly a danger to themselves/others, then sure, give quetiapine or whatever. Otherwise I agree with the above--we don't sedate patients just because it's convenient for nursing. Kind of how we don't round on patients at 5am (if we can avoid it--I get OR's have start times), wake them up and ask a few questions, knowing it'll go quicker because they're still sleepy.

 

[Lee Ik-jun MD]

Hi there,

I am currently admitted for medicine and am running into an issue with ED nurses always calling about agitation to get prn meds like Haldol/zyprexa. For example, there would be a pt coming in for AMS, waiting for a bed on the floor, but the pt would be somewhat loud but hyper fixated about leaving. However, the agitation is re-directable but still wants to leave. Nurses would continually call about "pt is trying to leave" "pt called an uber" "pt is agitated" but everytime I visit him, like 4-5x, he would be sitting down or laying down, just somewhat loud but not violent or demonstrating major motor agitation. I even saw a nurse/tech outside the door shouting at the pt to shut up. Do you just give in to the nurses asking for prns?

let me start by saying my mother is a Nurse. who identifies as a doctor most of the times.. can't wait for Thanksgiving!
Because they do the same thing over and over again, they feel like " everything is agitation, and solution is sedation "

The ED Nurse is calling you to sedate the patient, so they can finish their charting or attend to another patient. they want to have an easier shift
At the end of the day.. "my license, my rules" which translates to , if you don't think he needs it, then don't give it.
Primum non nocere, I think is exclusive to us physicians. ( correct me If i'm wrong)

 

[dozitgetchahi]

Reading the title of the thread, I figured this would be about how you manage the agitation of the ER nurses as a physician (which, in my experience, is also an issue worth discussing).