Psychotropic Medication

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When the physician writes an order for forced psychotropic medication, often the inmate is already in or being placed in restraints, or, at a minimum, being held by correctional staff. Just as the shot is about to be given, the inmate appears calm. Can we force the medication? Also, the psychiatrist usually orders a kind of “cocktail,” which may be a mixture of short- and long-term medications. Should our nurses not administer the shot because the inmate is “calm” and the longer-acting medicine is a therapeutic intervention?

Anyone know Solomon’s phone number? Let’s start with the intent of standard I-02 Emergency Psychotropic Medication: “...to have a protocol for emergency situations when an inmate is dangerous to self or others due to a medical or mental illness and when forced psychotropic medication may be used to prevent harm, based on a physician’s order.”

This emergency intervention by physician’s order is a therapeutic intervention that is used when all else fails. The longer effect of some portion of the medication is a positive outcome for such interventions, and medications are often chosen precisely for this effect. If the inmate can clinically tolerate it, such a 2/1 intervention can be the door that opens the inmate to healing. The nurses need to discuss the issues with the ordering physician so they understand such orders. For example, at staff meetings ask the psychiatrist to explain the therapeutic effects. That is why you consulted the psychiatrist in the first place—for expertise in safely calming an inmate.

The restraint is merely a temporary calm in the storm; without the medications, you soon will be back where you started. If the inmate appears calm when you are ready to give the injection, you certainly should ask if he or she will take the medications voluntarily. If the inmate says yes, administer them with permission. If not, then force it as the physician ordered.

The whole intervention should be done quickly and at the time the inmate is upset; in fact, that is the only time a physician can order such an intervention. Usually, once the medications take effect, the restraints can be removed. The physician usually writes the restraint order as “up to X hours until in control.”

You can ask the physician to write the injection order such that it’s up to the judgment of the staff that’s about to give the med, but that would lead me to wonder if you are using the forced medication intervention too easily. Many inmates requiring such intervention will fight the restraints and the shot.
— From CorrectCare Volume 21, Issue 3, Summer 2007