A nurse on the medical surgical floor is caring for an elderly patient with dementia. The patient's adult child is staying with the patient during the hospital stay. The patient's dementia and confusion are worse at night in a phenomenon known as "sundowner's." The doctor has an order for the patient to receive alprazolam 1 mg po q
Explanation
•Medications ordered by the doctor to be used for anxiety as needed are only to be administered as directed for anxiety. Using these anxiolytics as a means to keep a patient in bed is considered a chemical restraint.
•Any restraint order, whether chemical or physical, requires assessment by a physician for necessity every 24 hours.
•An order for alprazolam (Xanax) at bedtime for anxiety should not be used to keep a patient in bed. Other alternatives should be attempted, like diversionary measures, rest breaks for the family member, or a hospital provided sitter for patient safety. It is appropriate to administer the alprazolam to the patient at bedtime only if the patient is agitated or anxious.
•If other medications are required, the doctor should be called to discuss the situation. At that time, new orders can be given for chemical restraints if needed.