[RNDYN2CU]

I am looking for feedback from other RN's, I've been in Hospice 8 months, LOVE it, got questions, I'll put em' out there, who knows, maybe I'll get some feedback!
Here's my glitch: got a pt. on dilaudid via PCA/CADD in a longterm SNF, came in with a PIC line, Pain outa control (poor woman, ca of spine). PIC failed, tried SQ, no go, (Still moaning...) started regular IV. I want to find a Policy and procedure to submit that allows us to administer IV pain med for our Patients that NEED it.

QUESTION. does anybody know if there is a policy and procedure out there that allows an LVN to at leaste press the pre calibrated "dose" button on a dying patient's PCA to a regular IV line, in a SNF, this woman's pain is off the charts and an RN is not always on shift... ANYONE????? THx
Nurse Leslie

[Tweety]

Welcome. There's a Hospice Nurses Forum here: http://allnurses.com/forums/f25/


Sometimes it takes a while to get answers. Good luck.

[suebird3]

Welcome to allnurses.com! I moved your post to the Hospice Forum, where you are sure to get more responses.

Good luck!

Suebird

[doodlemom]

Originally Posted by RNDYN2CU

I am looking for feedback from other RN's, I've been in Hospice 8 months, LOVE it, got questions, I'll put em' out there, who knows, maybe I'll get some feedback!
Here's my glitch: got a pt. on dilaudid via PCA/CADD in a longterm SNF, came in with a PIC line, Pain outa control (poor woman, ca of spine). PIC failed, tried SQ, no go, (Still moaning...) started regular IV. I want to find a Policy and procedure to submit that allows us to administer IV pain med for our Patients that NEED it.

QUESTION. does anybody know if there is a policy and procedure out there that allows an LVN to at leaste press the pre calibrated "dose" button on a dying patient's PCA to a regular IV line, in a SNF, this woman's pain is off the charts and an RN is not always on shift... ANYONE????? THx
Nurse Leslie

I think that it is probably up to the facility. Most hospitals and NF don't allow any of their nurses to press a PCA button - and will tell family members not to press it either. We've written orders that state "nurse may give bolus dose per PCA" and that has worked. I can't imagine why it would need to be an RN considering that the CADD pump is controlling the dose. It sounds like you need to increase the basal rate quite a bit. Does your hospice have continuous care nurses? If so, she/he could stay with the patient and give doses until comfortable - then you could calculate how much the patient is needing and get an order to increase the basal rate. We recently had a patient that came home from the hospital on dilaudid pca and we started her on methadone and titrated the dilaudid down until she was off. She was much more comfortable on the methadone. Just a thought - if your medical director is comfortable with methadone.

[sassy1954]

I have been working for a hospice for 4 months but maybe I can help. We use Dilaudid also but what kind of pain is she having? Are you using any other meds to go with the Dilaudid? Ibuprofen for bone pain or Elavil or Neurorest gel for the nerve Pain? Why did the sq route not work? Can you increase the hourly dose and the prn dose? Not sure about the policy.
Nurse Kathy

[EmptytheBoat]

doodlemom wise to suggest methadone. You may also wish to try a longer-acting opiod depending on pt's allergies, Dilaudid usually used for breakthrough pain. You may also wish to get patient on some Ativan/Xanax
and a steroid if not already. Just my thoughts. Good Luck!

[doodlemom]

Originally Posted by sassy1954

I have been working for a hospice for 4 months but maybe I can help. We use Dilaudid also but what kind of pain is she having? Are you using any other meds to go with the Dilaudid? Ibuprofen for bone pain or Elavil or Neurorest gel for the nerve Pain? Why did the sq route not work? Can you increase the hourly dose and the prn dose? Not sure about the policy.
Nurse Kathy

What is neurorest gel? Is it a compounded neurontin gel?

[RNDYN2CU]

Hey thanks for the feedback!!! My poor poor patient is still hanging on with ungodly amounts of dilaudid, valium, toradol, Haldol, Solumedrol... was on Roxanol for BTP hell, she's not had anything but BTP, few moments of rest... she started seizing and we dc'd the Roxanol. I have never seen a human in more pain, I can only imagine what the Lumbar cancer and mets is doing to her... The chaplain came, the family has been in, I got a priest to give her her last rights, I don't know... Yes she is on continuous care, running out of staff available, I gave three full RN days, Lvn gave nights... THis case has taught me a lot and I am definately looking for mor pain management information to be ready for a case like this or mybe refer the patient to anacute setting for pain mngmt.

[steelcityrn]

Sounds like you have done about all that you can do. It usually does take several classes of pain meds when you get to that point. May she not suffer much longer, thats very very sad .

[doodlemom]

Originally Posted by RNDYN2CU

Hey thanks for the feedback!!! My poor poor patient is still hanging on with ungodly amounts of dilaudid, valium, toradol, Haldol, Solumedrol... was on Roxanol for BTP hell, she's not had anything but BTP, few moments of rest... she started seizing and we dc'd the Roxanol. I have never seen a human in more pain, I can only imagine what the Lumbar cancer and mets is doing to her... The chaplain came, the family has been in, I got a priest to give her her last rights, I don't know... Yes she is on continuous care, running out of staff available, I gave three full RN days, Lvn gave nights... THis case has taught me a lot and I am definately looking for mor pain management information to be ready for a case like this or mybe refer the patient to anacute setting for pain mngmt.

It seems like this would be a good case for terminal / palliative sedation.