Docs don't allow enough time to sedate

  1. Our Docs are so time focused lately that they often start procedures before the patient is adequately sedated. Most of them refuse to "wait a minute" for the last dose to take effect and either continue pushing (even if the pt is screaming) or give excessive amounts in rapid succession sometimes over sedating the pt and we have to give narcan in the middle of the procedure. They don't seem to learn from their mistakes and they are rude and intimidating to the less experience nurses.

    I'm sure we're not the only endo facility with this problem.
    What are other facilities doing to train the docs??????
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  2. 19 Comments

  3. by   canoehead
    Geez, what a bunch of duck farmers. (quacks)

    Refuse to give more meds until the first ones have had a chance to take effect. Offer to give the first dose as the doc is getting ready so they don't have to wait as long. Otherwise they'll have to suck it up. Remember the Versed so the patient doesn't recall the pain.

    If the pt was screaming in pain and the doc wouldn't stop I would make out an incident report. At my hospital the need for narcan gets a chart review- but sats dropping, apnea etc I think would be an incident anywhere, especially if there is one doc in particular...

    If all else fails he administers his own drugs, and the nurse stands close to the code button, hitting it at his/her OWN discretion.
  4. by   patsue53
    Scopette, this problem is pretty universal. To many docs a procedure is money and the faster you go the more $$ you can make. It's unfortunate but true. We've been known to plant ourselves in front of the "orifice" in question and not move until the patient is sedated. During procedures you can speak up and suggest waiting, tell the doc why the patient shouldn't have another dose, or hand the syringe to the doc and tell him that you can't in good conscience administer more at this time. I once walked out of an ERCP before medicating when the doc insisted that the patient be positioned on her belly even after I told him that when she was on her belly she went into Vtach and her breathing was labored. When he insisted that I was an idiot and didn't understand heart rhythms I left the procedure and went to my NM and told her I refuse to kill a patient in order to satisfy his ego. I reentered the room with my NM, grabbed a stethoscope and listened to the patient's lungs and related to the doc that the patient had crackles in both lungs. The woman was in heart failure and we ended up admitting her to ICU. (and no...she did NOT have an ERCP that day.) And in case you're wondering, no, I did not receive an apology or acknowledgement of any kind from the doc and I did write him up.

    These can be very difficult and touchy situations. Just follow your own best judgement.
  5. by   endomarge
    Well I have heard all these complaints before!!!!!!!!!!!!!!!!!Yes GI docs are one of a kind....all they think of is getting to the cecum at any cost to the patient. I have heard patients SCREAM STOP
    guess what he stops and says to the patient...I am not doing anything....................what a laugh..... I reallly believe that the docs schedule to many procedures.............come late............want to leave early...............and get to the office to torment other patient...............All most docs see are $$$$$$$$$$$$$$$ signs. Their reimbursement is so poor that they now feel they have to do twice as many procedures to make the same amount of money. Yes most docs do not wait for the sedation to take effect and we have some that will WAIT.......................Maybe in the future we will have better diagnostic tools to see the colon that will not be invasive.....I believe this is on the horizon.....
    Here in San Jose the Colon Scan is popular....right now Insurance
    company's will not cover the procedure but they will..remember when Mammograms first were available insurance companys would not reimburse that test either...but now they certainly do.....SO this is all I have to say............................................... .....
    just do not go to the doc that allows his patients to SCREAM with pain.....I certainly do not!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!
    : :chuckle :roll
  6. by   suzannasue
    The practice of not allowing adequate time for pt sedation prior to procedures is a universal problem. Have been at the bedside of many a patient having toes amputate,wounds debrided, fasciotomies, etc...and the pts rarely if ever are given the right meds...4mg of Morphine 2 minutes prior to any of the above is a Godsend, but is of NO HELP...had one doctor tell me during a bedside toe amputation,while I was begging for medication for the screaming pt who was also begging for relief...."Americans are
    pu****s and dont know what pain is all about" wrote up the incident and all administration had to say was that the doctor was from a different culture and that the pts toe was falling off from gangrene anyway...<sigh>...very different to be a pt advocate when the bad behavior of docs is excused...
    Have had pts recently with Ca who recieve 1/2 of a Darvocet N-100 TID for pain...administrations excuse has been that the doc is afraid of making addicts...<sigh>...also work wth a doc who has branched out into gastroenterology and brags that he can do an upper and lower scope in 10 minutes...ummmmm..I dont want anyone rushing into any orifice I have!!!!!!!! The sedation they recieve usually does not take effect until after the procedure...I can only offer yall support and hope for the day when the doctors become interested in the pts and not the profit....
  7. by   researchrabbit
    Originally posted by endomarge
    All most docs see are $$$$$$$$$$$$$$$ signs. Their reimbursement is so poor...
    :roll
    They should get paid what we do!
  8. by   ButtRN
    Geeze, I don't know if I would work where you all have worked?!
    I work in a very busy Endo Unit, we primarily use IVCS for our cases, including ERCP's. Maybe because all the docs do so many cases in my unit, they have become skilled. But on the whole, I have to say, patients are comfortable and sedated! The docs are really concerned about comfort and we still can get in and out of cases quickly! And it is very rare that we need Narcan/Romazicon! Even where I used to work, the docs there too were good about sedation. It's a shame to hear there are so many jerks practicing GI! If they waited just a few minutes, the case would probably get done quicker! I think the docs I work with have learned that! And many of them do several procedures in a 3 to 5 hour slot! Good luck Scopette!
  9. by   mdslabod
    I
    Last edit by mdslabod on Jun 23, '03
  10. by   mdslabod
    Last edit by mdslabod on Jun 17, '03
  11. by   maire
    Eek, you guys are scaring me.
  12. by   sjoe
    Horror stories.

    The colonoscopies I have had, I agreed to ONLY on the condition I would feel nothing. That is exactly what happened. When I woke up, I had to ask whether it had been done yet. Thanks again, VA.

    Nurses shouldn't have to stand guard over their patients' butts to keep them from suffering. The hospital policy needs to be changed so the patients are sedated WELL before falling into the hands of a doc with an ice-cold, 10 foot black rubber tube. IMHO.
  13. by   Scopette
    Thanks everyone who replied to my posting. It is always helpful to know we aren't alone out here! I have shared the responses with my co-workers. And we are working on some 'documentation/tracking forms' starting with tracking use of narcan. Pharmacy had requested us to track use many, many years ago.......but at the time, some of our docs were using it routinely after every case!!! and after recieving 100 reports in less than 2 weeks they begged us to STOP reporting to them.............:imbar :imbar But now we rarely use it; so tracking might prove useful.
    Does any one have MAXIMUM dosage limits??? we don't have any set in our policies, and anesthesia avoids answering when we ask them.
  14. by   dianah
    Maximum dosages (mg/kg or mcg/kg) for meds administered by themselves or in conjunction with other meds (e.g., Fentanyl and Versed) should be clearly stated in your facility's Sedation/Analgesia Policy. Who wrote your current policy? To whom could you go for clarification? (try Risk Management, or the person overseeing JCAHO compliance) This is not a minor question. Let us know what you find out. -- D

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