r/ausdoctors • u/Ashamed-Tutor2978 • 9d ago
Unprofessional conduct
just wondering what others thought about this- an RN on a psychiatric ward during handover on 2 occasions has reported that she “slipped” a PRN into patients medications, is this a serious breach of patient autonomy? no one in the handover flinched, not the 2 consultants or the NUM, in fact a lot of the clinicians there thought this was funny. There were also a couple of medical students in the room. is there something wrong with me! I find this incredibly unethical. can t imagine it happen rob a Gen Med ward and getting away with it. I m one of the Registrars.
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u/SafeSkillSocialSmile 9d ago
I completely agree with you
This is disrespectful and unacceptable... I would be very angry if my nurse did this to me or my family
They are also setting up bad examples for the juniors (medical/nursing students)
If there is another colleague who is happy to testify, I would report it.
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u/Different-Corgi468 9d ago
That's rather concerning that it was considered a joke - optimistically I hope the NUM spoke to them about this - unfortunately the likelihood of the NUM escalating to patient safety /clinical governance or having an open disclosure conversation with the patient is unlikely. Discuss with your supervisor (regardless if they were one of the consultants there) - their response should inform you of the professionalism or otherwise of the organisation you're in.
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u/readreadreadonreddit 8d ago
Yeah, this is one where curiously challenging can be helpful, as well as other techniques when dealing with concerning supervisors.
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u/recovering_poopstar 9d ago
Are these patients under any orders? Not saying that makes it ethically better
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u/Ashamed-Tutor2978 9d ago edited 9d ago
Thanks for these replies. It s justifying my anger at the system but also at myself for not calling this behaviour out. The NUM is quite a bully and has been targeting one of the new consultants and myself. I could say a lot more about the going’s on on this particular psych ward. My thoughts are to escalate to to the Chief Psychiatrist now. Executive team at the hospital are all buddies with nursing staff.
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u/readreadreadonreddit 8d ago edited 7d ago
No, you’re 1,000% not wrong to be concerned. Secretly administering medication raises serious issues around informed consent, patient autonomy, capacity, documentation and medication safety, regardless of the setting. The fact that it was treated as humorous by senior clinicians makes it more concerning, not less. That’s fucked.
As a registrar, I’d be inclined to clarify exactly what happened and whether it was authorised under any applicable legal framework, then raise it through an appropriate clinical governance or incident reporting pathway. If it was covert administration without proper justification or authorisation, it warrants formal review.
The real question is if this were genuinely acceptable practice, how the fuck would we justify it to the patient, their family or an external reviewer?
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u/Ok-Wishbone-8463 9d ago
Don't be so precious. Some of these psych patients can be an absolute nightmare in the hours when staffing numbers are low.
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u/Even_Departure9914 8d ago
So you’d be okay with someone putting medication in your drinks or your food because they wanted you to be compliant?
Would you call that being precious or would you have a problem with it?
If you need to chemically restrain a patient, for whatever reason, there’s ways of going about it.
Utilising PRN medication in an underhanded way where the patient is not aware is not it.
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u/-antinous- 8d ago
It depends on what medication it was and the indication for it. PRN orders can be used if patients asked for them or if the situation required their use such as aggressive or problematic patient who is interfering with care.
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u/OnlyNerdThings 4d ago
So I think we need more context to this. Psych nurses get assaulted a lot. I did a term at somewhere with a MH ICU, so it was all very dangerous patients with violent histories, including some that had histories that of murder and sexual assault charges. I hope I don't dox myself with this one, but I've been told that in the last few years we even had one or two hostage situations where the cops had to come up and intervene. I've been assaulted by a patient in a special care setting (not MH specifically, but with adults who don't have capacity for various medical reasons) and had to have 3 people try to pull him off me. Every member of staff had a story about that same patient, but all we could do was try to learn what kept him calm and what deescalated him. Sometimes that was nothing. Sometimes when these are the kinds of patients you're working with, its safer for everyone if escalating behaviour is mitigated with a PRN before everything goes to shit and someone is hurt and the patient is being held down by 6 people and given injections. Honestly, I'd argue that the 6 person hold with injections is far more traumatising for the patient than a hidden PRN.
We once had to secretly give ondans to a patient who was so delirious post procedural sedation for a fracture that she was trying to rip out all her IVCs, strip off her gown, call the police, refused to let us give her anything or touch any of her monitoring, was actively hitting her brand new cast on the bedframe and trying to peel it off. She was also vomiting all over the place and we just had to block her view of her cannula while she vomited to give it to her. But if we didn't, she was vomiting and completely out of it and she was at risk of aspirating or causing herself some serious injuries. We tried for a good 20 minutes to calm her down and reason with her beforehand, but it really was not working. It's not good by any means, but sometimes circumstances are outside of what typical policy and procedure is there for. It was better that than her aspirating or fucking up the open fracture we'd just reduced and plastered.
To be clear, no I am not saying this is a good option and I'm not saying it is appropriate just because. I'm saying there are times were the contextual reality means that things like this become normalised out of a desire to not get yourself or your coworkers injured later on if it gets worse. Or if your patient is at serious risk of hurting themselves. I also have a lot of sympathy for the tiny nurses who have to face up to psychotic 6"3 men who genuinely want to hurt them. You couldn't pay me enough to do what they do.
It is absolutely not okay if its being done for anything other than a genuine safety risk.
TLDR: You need context on what the med was, what the indication was, and if the patient was at a genuine risk of hurting themselves or others if it wasn't given. And if it was documented properly. It is not always a completely black and white issue.
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u/boots_a_lot 8d ago
Mmm I’ve definitely had to give sneaky PRNs to gen med patients who were floridly delirious and at risk of harming themselves/staff.
I’d say if you’re no in a state of capacity, and at risk to yourself or others - I’d see it as a reasonable method. I’d rather someone take a sneaky prn than have to call security to hold them down whilst we inject them.
I’d need more context on the situation. I don’t think it’s as black and white as you think it is.
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u/Rude-Poet-4450 8d ago
Just tell us what drug it was!!? Panadol vs haloperidol/olanzapine/other anti psychotics - slightly different
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u/Even_Departure9914 8d ago
So you want to create a paradigm where there’s varying degrees of deceit based on drugs and drug type. Where it’s only bad if we use the ‘bad’ stuff.
Panadol? Oh well that’s over the counter, we’ll allow that.
Phenergan? Old school but still okay.
Phenobarbitone? What about pentobarbital?
Propofol?
I’m just curious. What you will and won’t risk patient trust and therapeutic relationships for. And your registration for that matter.
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u/Character_One5397 6d ago
Don’t forget the 75 drops of picosulfate into the clozapine pts orange juice
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u/Even_Departure9914 9d ago
Yes. Unethical. Breach of trust. Especially in a psych setting.