Antipsychotic Medications: Nursing Implications
Monitor for Side Effects:
Over sedation, orthostatic hypotension, unsteadiness, extrapyramidal symptoms (EPS).
Mood Stabilizers
Lithium, Depakote
Indications:
Administered to non-consenting patients under involuntary commitment if: impaired illness or med prevents serious harm
Medical Director Review:
Ensures application completeness.
Decides if hearing is required.
Convenes Non-Emergent Medication Review Committee.
Vivitrol
Administer Monthly
Common doses: 380 mg
Baseline Assessment:
Use Abnormal Involuntary Movement Scale (AIMS) before starting treatment.
Antidepressants
Prozac, Paxil, Lexapro, Celexa,
Zoloft, Effexor, Remeron,
Wellbutrin, Cymbalta, Trazadone
Eligibility:
No prior commitment hearing required.
Illness severity must impair understanding of medication necessity.
Patient either does not or cannot consent.
Patient Rights and decision process
Right to meet with a Patient Advocate and an Option to include family in the hearing.
Held in the patient’s unit, committee deliberates privately. Requires majority vote including a chairperson. Patient informed of the decision on the hearing day; 24 hours to appeal.
Invega Sustenna
Administer: Monthly
Common doses: 117 mg, 156 mg, 234 mg
Follow-Up Assessment:
Reassess for abnormal involuntary movements after 8 weeks, then every 6 months.
Anxiolytics/Hypnotics
Ativan, Xanax, Klonopin, Valium,
Restoril, Ambien
LIP Documentation:
Licensed Independent Practitioner (LIP) documents
Medication Administration Timeline:
Initial Period: 14 days post-hearing notification.
Extension: Up to 90 days if requested by LIP and approved by Medical Director.
Aristada
Administer: Monthly or Every 2 Months
Common doses:
Monthly = 441 mg, 662 mg, 882 mg
Every 2 Months = 1064
Special Populations:
Monitor patients with Parkinson’s and seizure disorders due to risk of parkinsonism and lowered seizure threshold.
Avoid antipsychotics in dementia patients if possible.
Monitor closely for cerebrovascular or cardiovascular adverse effects.
Antipsychotics
Risperdal, Seroquel, Clozaril,
Mellaril, Abilify, Zyprexa, Geodon,
Haldol, Invega
Notice of Hearing:
Given 1 day after approval and 1 business day before the hearing.
Committee Members:
Chairsperson
Social worker
Administrator
Patient advocate and patient’s LIP
Haldol Decanoate
Administer: Monthly
Common doses: 50 mg, 100 mg (ampule), 150 mg (ampule)
Assess for Alternative Causes of Disruptive Behavior:
Look for signs of delirium, pain, fatigue, hunger, incontinence, or infection.
Document medication error by completing the Patient Incident Reporting in the Applications tab and notify LIP, charge nurse, ADN, nurse manager and Pharmacy.
Wrong dose or Wrong time
Hearing Timeline:
Scheduled 2-5 business days after approval.
Decision on hearing day; patient has 24 hours to appeal.
What does NEIMAR mean?
Non-Emergent
Involuntary
Medication
Administration
Abilify Maintena and Risperdal Consta
Administer Monthly
Common doses: 300 mg, 400 mg
Administer every 2 weeks Deep IM Deltoid or Gluteal
Common doses: 25 mg, 37.5 mg, 50 mg