Administering pain meds to a sleeping pt - page 3

I'm a new nurse and recently received my first "negative" comment on a patient survey. Pt was a young woman s/p lap appendectomy; she complained that I "must have forgotten" about her pain meds... Read More

  1. Visit  mbuchanan2107 profile page
    1
    When I worked night shift I would talk with my patients that I thought would have more pain before they went to sleep. I would give them their nightly meds and ask if they would like to just be left alone throughout the night, or would they like me to come and wake them to take them and they can decide if they want to be medicated. Only a few times did I medicate with IV narcotics when someone was asleep, and that would be the med seeker that no matter what would request the meds exactly on time and I can verify they get it say Q4hr on the dot for the past few days. Being a newer nurse you have to learn judgement calls, but you need to always make sure you are looking out for the patient. They do not know how some of the meds work like you do, and what they "think" could harm them. Don't worry, it is one survey and one patient. You will get more that just don't like you for whatever reason or give you a bad review.
    tyvin likes this.
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  3. Visit  MunoRN profile page
    9
    Quote from vashtee
    I don't wake sleeping patients for PRN pain medications (unless terminal) if they appear to be comfortable. Am I the only one who uses the FLACC scale to assess for pain?
    FLACC is for pediatric patients or patients without verbal abilities, it is not validated for use in sleeping adults.

    Patients can be asleep and appear comfortable and still be experiencing significant pain and/or get behind on their pain control.
    LPNnowRN, nopainNurse, rnmi2004, and 6 others like this.
  4. Visit  MunoRN profile page
    3
    Quote from rn/writer
    Yeah, sometimes it sounds like we get bonus points for every PRN med we don't give. With that in mind, we surely wouldn't want to bring the subject up. And if a call bell goes off and someone actually asks for one, dang! there go those points.

    It'd be funny if there weren't nurses who actually function like this. I know, because I've had some of them. And so have family members.

    We ARE supposed to bring up the subject and assess, with the patient, whether additional meds are needed or not. That's a big part of our job!
    And when they do call to ask then we label them as a "seeker"; either way they lose.
    Not_A_Hat_Person, xtxrn, and OCNRN63 like this.
  5. Visit  xtxrn profile page
    0
    Quote from mbuchanan2107
    When I worked night shift I would talk with my patients that I thought would have more pain before they went to sleep. I would give them their nightly meds and ask if they would like to just be left alone throughout the night, or would they like me to come and wake them to take them and they can decide if they want to be medicated. Only a few times did I medicate with IV narcotics when someone was asleep, and that would be the med seeker that no matter what would request the meds exactly on time and I can verify they get it say Q4hr on the dot for the past few days. Being a newer nurse you have to learn judgement calls, but you need to always make sure you are looking out for the patient. They do not know how some of the meds work like you do, and what they "think" could harm them. Don't worry, it is one survey and one patient. You will get more that just don't like you for whatever reason or give you a bad review.
    How about the patients YOU didn't think would have more pain? What happened to them? Were those the med seekers?
  6. Visit  rn/writer profile page
    1
    Quote from MunoRN
    And when they do call to ask then we label them as a "seeker"; either way they lose.
    They don't get labeled seekers by me. I tell my patients to call, even if they said earlier they were fine and were sure they wouldn't want anything until morning. I make it clear that they can change their mind at any time, and I'll get what's ordered, so long as we stay within the prescribed boundaries.

    I don't believe I get bonus points for every PRN net administered.
    xtxrn likes this.
  7. Visit  chevyv profile page
    1
    I would not want to be woken up for a pain med. It's hard enough to get sleep when your a pt in a hospital so I would not have woken them up to offer pain meds. If your in pain, you wake up. I like the comment about asking before they go to sleep to see if they would prefer being woken up. I'll do that from now on.
    Not_A_Hat_Person likes this.
  8. Visit  linearthinker profile page
    0
    Only read the OP. Short answer, no, never.
  9. Visit  linsmirn profile page
    0
    just out of school here so i'm not speaking from experience. i was thought just because a patient is sleeping doesn't mean they don't have pain, so i would wake them and apologize and ask if they are in pain.
  10. Visit  MunoRN profile page
    0
    Quote from linearthinker
    Only read the OP. Short answer, no, never.
    It's never appropriate? Any particular rationale behind that?
  11. Visit  Spritenurse1210 profile page
    1
    I always educate the patient about which pain meds are scheduled and which ones they have to ask for. I wake patients up for scheduled pain medications. Depending on the reason the patient is on my floor is if I wake them up for prn pain meds. We get a LOT of cancer patients and patients that are not able to vocalize their discomfort. For these patients I give them prn pain medications when I can as ordered by the doc and as long as they're not sedate. Also if the patient is contracted and or has a feeding tune, you bet I'm giving them something for pain ( usually those I get can't talk or communicate at all) relax and realize that patients are fickle. Make sure to document and follow md's orders and you will be fine. Also if the pain meds that are ordered aren't working for the patient the md should be notified.
    carolmaccas66 likes this.
  12. Visit  linearthinker profile page
    0
    Quote from MunoRN
    It's never appropriate? Any particular rationale behind that?
    The OP asked:
    "But would you wake a sleeping pt to give them a PO pain med?" She didn't ask is it ever apppropriate, she asked would you. I stand by my response. I have no idea what has transpired since the OP.
  13. Visit  carolmaccas66 profile page
    1
    As Flo says, in many units I've worked in, u must wake people up.
    The doctors who perform the ops also annoy me, cos they tell people 'you will have pain relief and will have NO pain', which is inaccurate. They should be saying we will control your pain the best we can, so that you are comfortable'. Some patients don't respond well to any pain meds, pumps or whatever.
    I wouldn't wake them for a prn med either. I would wait for them to ring the call bell. If they couldn't (dementia or whatever), I would give all meds as charted.
    If meds aren't prn, they get woken whether they like it or not and get given them medication.
    Patients will always find something to complain about, especially when they have pain. She is just blaming u for having pain. Why didn't she ring her call bell for something - did u ask her - or couldn't she be bothered.
    We are not mind readers, and generally, if people are sleeping comfortably, I do not wake them for prn meds.
    Just say something like: My crystal ball wasn't working that night!
    I reckon u did the right thing - she is just whingeing and whining (as usual with these types of patients), & just wants someone to blame.
    xtxrn likes this.
  14. Visit  Mgrn123 profile page
    0
    Happens to the best of us. Chart chart and chart. In this situation check her Bp pulse etc.... Tell her u do it at night while she is awake so u don't scare her. Check her hx of meds administered if she has been there a while and based on that judge if she needs pain meds. low Bp hr etc don't do it abnormal hr Bp etc she may be in pain. Hope this helps!


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