Brief Answer:
Notification of physician

Detailed Answer:
Good morning from the XXXXXXX OH region of the world.

My name is Dr. Dariush Saghafi and I am a neurologist. I am very sorry that the patient is having this many complications and hope that things improve soon. I have also read your other queries to other colleagues so I understand things have been progressing and seem to be complicated.

Although you do not specifically indicate why the Haldol is being used I am assuming that there are issues having to do with the patient's dementia/delirium and their care. I also understand that there is a component of pain being treated and perhaps, the thought has been to use a sedative such as Haldol as a work around to specific analgesics which may precipitate other types of complications with respect to this picture.

Therefore, in answer to your questions:

1. If 0.5 mg of haloperidol IM has no effect at all after two hours then is there any need to report the lack of effect to a doctor when one becomes available?

>>> Again, I am making an assumption but when you say "lack of effect" I take that to mean that either the patient's pain level or complaints have not decreased or that their mental delirium has not improved as hoped with that particular action. It really depends how the doctor wrote the order of the Haldol injection and what the standard nursing care practice of the particular hospital is when it comes to informing the doctor of such things. My guess is that the nurses who are monitoring the situation are choosing NOT to notify the doctor in this case of any lack of efficacy of the medication simply because there has not been any WORSENING of the condition. And therefore, they are continuing to handle things as they have been until the doctor reports or asks for an update. Sometimes a doctor will specifically instruct in the orders that if an acute medication for a particular condition does not do its job as expected to either readminister another dose or to call the physician for further instructions.

2. Does it really matter if a doctor is not informed? Why?

>>>> By not being present myself to know this patient and the condition that is occurring necessitating the sedative power of Haldol I believe that question is difficult to answer. Again, referring back to the answer of my last question. The absolute NEED TO INFORM the physician is likely contingent upon the overall thought process of the doctor himself and the standards set by nursing for informing doctors of such things. If clinically, all has remained static then, perhaps nursing believes there is no need to inform the doctor of anything until he next calls for an update or visits the patient personally. My guess is that if the situation were to deteriorate medically, mental status wise, or pain were to increase that the nurses would immediately connect with the doctor.

So to bring it full circle, I'd recommend you consider having a conversation directly with either the nurse in charge of the patient as to what their standards are with respect to informing doctors on such matters. Also, I believe you would be well within bounds to ask the doctor directly what his/her overall plan would be as well as their expectation levels for treating your family member or friend in terms of "need to know" issues such as what you've raised.

Often times there is a disconnect between what doctors perceive as medical need to know when it comes to orders and patients or their families. I find that a simple conversation can usually clear up such misunderstandings quickly and tends to put families at greater ease knowing that while it may at times appear that nobody is "tending the store" that in fact, good vigilance is being kept.

Best of luck in this situation. If any of what I've mentioned has helped answer the 2 questions you've asked I'd appreciate your written feedback and a STAR RATING at your earliest convenience. In addition, please feel free to forward additional questions or comments to this response if you'd like or if things are well as they stand you may CLOSE THE QUERY on your end which will signal to the network that we are ready to archive and credit the thread for future reference.

This query required 37 minutes of physician specific time for review, research, and final draft documentation for envoy.

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