Is it legal to manage an antipsychotic drug intramuscularly for severe agitation in adults in psychiatric wards against their will?

Question:

Dear Nancy,

Is it legal to manage a continuous IM PRN antipsychotic for severe agitation to adults in psychiatric settings against their will? If not, within the absence of a transparent hospital policy, what state or federal regulations do organizations have that provide clear guidance on this practice? In my workplace, the medical director, unit manager, and most nurses insist that the practice is correct and legal and that there is no such thing as a must call a psychiatrist to forcefully administer an IM antipsychotic or benzodiazepine for agitation when the patient refuses.

Andy

Nancy Brent replies:

Dear Andy,

Your query can’t be fully answered within the context of this column. First, it will be significant to say that your staff needs legal advice from a facility attorney. If there is no such thing as a attorney representing the ability in clinical matters, consultation with a nurse, attorney, or attorney in your state is crucial to be sure that all clinical policies and practices are in compliance with applicable laws on this area. Although this will not be an exhaustive list, these laws include the state mental health code (or similar title), state and federal constitutional laws regarding the fitting to refuse treatment, and guardianship laws.

There is absolute confidence that a nurse can administer PRN medication (again, when it’s consistent with facility policy, third-party reimbursement requirements, and Joint Commission requirements, as examples). However, there are limitations in the world of ​​psychiatric nursing. For example, are the mental health recipients in your facility voluntary or involuntary? Is there a court order, if one is required in your state, to manage medication against the recipient’s will? How are standing PRN medication orders handled procedurally in your facility? What are the policies regarding restraint and seclusion, and the way do these policies help or hinder the usage of involuntary medication?

Suffice it to say that the indiscriminate use of psychotropic medications is unacceptable. There should be a clinical reason for administering medication that’s supported by legal and ethical imperatives. Psychiatric staff members have an obligation to guard the security of each patient, including the patient who’s agitated or uncontrolled. Restraint, seclusion, and/or medication are options in these situations.

If you are usually not already a member, you must consider joining the American Psychiatric Nurses Association. Its website, www.apna.org, comprises a wealth of data for general and member use. The Association’s Scope and Standards of Practice for Psychiatric Health Nursing could also be helpful to you and your staff. The Association also has a wide range of educational programs, webinars, and PowerPoint presentations focused on clinical practice on this specialized field of nursing.

Kind regards,
Nancy