Documentation by caregivers is extremely important to avoid litigation when chemical restraint is used. The person’s competency to refuse care including medication should be evaluated and documented. Caregivers are required to document other interventions that are tried to help the agitated person to gain control such as removal from stimulation or verbal intervention. In a nursing home setting, the person could be provided with food or fluids, toileted or distracted. The individual’s response to these interventions should also be documented.
The medications most commonly used for chemical restraint are benzodiazepines such as Ativan and antipsychotics such as Haldol or Risperdal (Mattingly, 2014). These medications may be used alone or in combination. Oral medication is the first option if the agitated person is willing to cooperate. Rapid onset is desired in emergencies so a liquid concentrate is often used. If the individual is not cooperative, an intramuscular injection may be given. This can be a traumatic event for both the patient and staff involved. Patients who have been sexually abused are particularly traumatized by being held down against their will and even having their pants pulled down for the injection. It is important for the patient’s vital signs and mental status to be carefully monitored after the administration of psychotropic medication. These medications can have severe adverse side effects that can lead to over-sedation, dehydration, cardiac events and falls. Failure to monitor a patient after administration of psychotropic medication is a violation of the standard of care.
This month’s civil topic is Chemical Restraints. Topics covered are:
- Documentation and Medications Used (11/3/14)
- Verbal Abuse Scenario (11/10/14)
- Bipolar Case Scenario (11/17/14)
- Nursing Home Case Scenario (11/24/14)
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