Psychopharmacology Updates: Know Your Patient's Medications
- Choose antipsychotics, antidepressants, antianxiety (Benzodiazepines), sedatives, mood regulators
- Anticipate and treat side effects
- Contraindications
- Design medication protocols for different disorders
- Solve legal implications related to psychopharmacology
Keep Your Patients and Your License Safe: Tips to Decrease Risk
- Medication - voluntary vs. involuntary
- Physician orders and unit protocols
- Seclusion and/or restraints
- Commitment
- Licensed and unlicensed staff: Utilization, training, comfort
- Specific training for seclusion/restraint and suicide prevention
- Screening and searching of patients and visitors
- Decreasing liability through charting, staffing & supervision
Trending Issues: Your Changing Responsibilities
- Opioid Epidemic
- Intoxication vs. withdrawal
- Drug seeking
- Narcotic and benzodiazepine antagonists
- Increase of Suicides
- Approved assessment tools
- Interventions including safety plans
- Prevention utilizing 1:1 supervision
- A BH/Psychiatric Bed is Not Available
- Commitment process
- Standards against jailing psychiatric patients
- Scarcity of psychiatric beds
New Skills to Address Your Patient's Acute Psychiatric Symptoms
- Scenario 1 - The patient is suspicious, resistant to treatment, fluctuates between anger and fearfulness
- Determine whether delusions or hallucinations are influencing thoughts and response to staff
- Distinguish between intoxication, mental illness or organic impairment
- Try out effective use of simple directions, presenting reality and giving choices
- Choose intervention and/or medication based on presenting symptoms
- Decide when/if restraints or seclusion become necessary
- Scenario 2 - The patient is hyperactive, impulsive, hypersexual or assaultive, becomes angry about staff intervention, refuses meds, is not eating or sleeping
- Distinguish behaviors due to mania, delirium, intoxication, or organic impairment
- Modify environment and decrease stimulation to increase safety and decrease behavior
- Scenario 3 - Patient is anxious to a panic level, fight or flight behaviors, manifesting high blood pressure, pulse, sweating, and increased respirations
- Distinguish behaviors due to anxiety disorder, delirium, dementia, or intoxication/withdrawal
- Modify environment, decrease stimulation, 1:1 supervision, toxicology/drug and other lab screens
- Keep verbal to minimum but explain procedures, give choices and observe/supervise
- Choose appropriate medication
- Decide if/when restraints and or seclusion necessary
- Scenario 4 - Patient fluctuates between calm, manipulative, passive behavior and demanding, angry, physically threatening (drug seeking)
- Assess for personality disorder such as antisocial personality, borderline personality or narcissistic
- Set and keep limits
- Assign same staff and keep consistency between staff and shifts
- Avoid medication but increase personnel or security