Pain control via PRN narcotics - page 2
Hi everyone, I have a general question regarding how you dose your patients with narcotics. Frequently we'll get patients in acute severe pain (kidney stones, dislocations, low speed MVCs) in... Read More
Nov 14, '12Quote from nurse2033Depends on nursing judgement. BTW not to be too picky but I've never seen MS packaged in 2.5mg. It comes in 2mg or 10mg.Quote from ~Mi Vida Loca~RNWe stock 10 and 15 mg/mL vials of morph. I don't know why the docs are so in love with 2.5 mg and multiples of same (5, 7.5 mg). The 10 mg/mL math is straight forward though.In my ER we have 2,4 and 10 mg Morphine vials.
I have literally never pulled a 15 mg vial because typically if the patient needed 15 mg in one dose we'd be going to something stronger.
Nov 16, '12Something else to think about: the typical PCA dose for morphine is 1-3 mg Q8 minutes. Until your docs start writing correct orders, that can provide a starting point for administration. Of course that assumes patients are being monitored appropriately.
Nov 16, '12OP, it sounds to me like your ED does not have a pain protocol, is that right? A standardized protocol developed in tandem betweeen your pharmacists and your medical director might be useful. It could just be a check box on the order sheet the doctor can check. For patients whose pain control needs are outside of the scope of the protocol, for example, someone who has been on opioids for ten years and has a very high tolerance, then the physician can write an order outside the protocol. It might be something you can suggest at an opportune time.
Edited to add: I think it's safer to give the lower end of the dose since you don't really know these people that you're seeing in the ED. It's not like on an oncology floor where you get to know your patients over the course of hours, days, and maybe even weeks. Also, your doctor's order is incomplete. They need to give a range of time, such as Q15-20 minutes, and the reason for the PRN, such as "for pain". There should also be a maximum cumulative dose, so that if you have given the max, and the pain is still unrelieved, you check back in with the doc.Last edit by Anna Flaxis on Nov 16, '12
Nov 20, '12The first time in the ED that you have an otherwise healthy pt, who just happens to have a painful situation going on, and you snow them to the point where you have to bag them or place an oral or nasal airway, or worse, they have to be tubed, you will never start on the high end again unless you are very familiar with that patient (frequent flier).
On the other hand, if you have someone in that much obvious pain, and you are giving IV narcotics, plan on checking on them in 15 minutes. That way, if their pain is still not well managed, you can give more. 35 minutes is unreasonable as a way of thinking. Obviously its and ED and something can come up that will delay you, but at least Try to get there and check on them quickly.
Also as has been suggested above, do Not be afraid of asking the doc to put times down. If you feel comfortable with choosing the dose out of a range go for it. If not, ask that as well. A good doc will understand you have the patient's best at heart, especially knowing you are newer in the ED. A bad doc, who complains, his/her opinion of you doesn't matter.