Dilaudid IV Push

Specialties Emergency

Published

Administration as started allowing physicians to order dilaudid IV push (& other opiates) in the Intake area of our Emergency Room. These patients are receiving this in a rapid treatment area with no monitoring/proper reassessment & no "one" specific staff person assigned to the patient. (patients are seen by multiple RN's in this area... one for triage, one for IV, one for meds, one for results, etc) This news was sent to us in the form of an email from administration with no policy attached. Some employees have asked to see the policy or something in writing from Risk Management, but to date no one has received anything. Anyone else experiencing this in their ER's? Anyone have any protocols addressing this issue? We fear if a sentinel event occurs as a result our licenses could be at risk. Who would be liable?

Specializes in Infusion Nursing, Home Health Infusion.

NO WAY would I ever do this. There are several problems here. It seems like an adequate assessment has not been completed,including an allergy history and complete pain assessment. The Joint commission (TJC) their new name, states there must also be an assessment after the administration to detemine effectiveness..are those policies in place...is there a nurse assigned to each of these patients????? How will the patient be monitored for drug hypersensitivity and/or side effects such as respiratory depression??? Is it even feasible to start an IV in a crowed intake area and keep the area clean and free from bodily fluids and exposure of these to other pts....YUCK. It seems to be another way to keep the customer "HAPPY" instead of fixing the problems of our overcrowded and improperly used EDs

Thanks everyone for your responses. We have our first meeting tomorrow morning & It really helps having the input of so many great nurses with invaluable work expertise. :yeah:

Specializes in PACU, ED.

http://www.fairview.org/static/scope_0803.pdf

http://www.thedoctors.com/KnowledgeCenter/Publications/TheDoctorsAdvocate/CON_ID_002959

There should be some worthwhile information in these two links. Respiratory depression is a big thing. I would question giving it to anyone who uses home CPAP. I know of a case of a woman who went to the ER C/O neck pain. They examined her, gave her PO dilaudid and sent her home. She neglected to put on her CPAP and her husband found her dead in the morning.

Yikes! Which proves the point that Nursing is not to be taken lightly AND admin does not always have our backs! Our practice is completely on us!

Specializes in ER.

I would probably operate under the personal code of "if I give it, I follow up on it." I don't feel comfortable giving Dilaudid and taking off - especially Dilaudid, I keep an eye on my patient's respiratory status and oxygen sats. I had a patient go south pretty quick after some Dilaudid IV - open tib/fib. Sats went into the 40's FAST even w/ slow administration. I don't think using IV Dilaudid is a good idea in a quick triage area - maybe IM or PO?

Specializes in ER.
Also, once the seekers learn about this, they can get their shot, then just get up and leave.

That's the best reason of all not to give it. No way!!!!! Give a med and have a person take off and drive away. Yikes.

Specializes in ER.
NO WAY would I ever do this. There are several problems here. It seems like an adequate assessment has not been completed,including an allergy history and complete pain assessment. The Joint commission (TJC) their new name, states there must also be an assessment after the administration to detemine effectiveness..are those policies in place...is there a nurse assigned to each of these patients????? How will the patient be monitored for drug hypersensitivity and/or side effects such as respiratory depression??? Is it even feasible to start an IV in a crowed intake area and keep the area clean and free from bodily fluids and exposure of these to other pts....YUCK. It seems to be another way to keep the customer "HAPPY" instead of fixing the problems of our overcrowded and improperly used EDs

starting IV's prior to a complete evaluation? Unless a person comes in unable to ambulate or intractable back pain, who has the time to do that all in the name of expeditious care at the front end? Please! Providers and hospitals are so eager to please the drug seeking population, why not offer Motrin/Tylenol PO for all at the door?

That's the best reason of all not to give it. No way!!!!! Give a med and have a person take off and drive away. Yikes.

I STILL don't know why we are giving out so much Dilaudid! This is a powerful opiate that should really be reserved for end stage pain. Why is every chronic pain pt. on it, and why is it so routinely ordered?

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