Is it my fault???

Nurses General Nursing

Published

Specializes in LTC.

I need to get this off my chest so to speak... It's been bugging me all weekend.. here's what happened.

Here's the background, pt has cancer and has radiation 4 days a week and has marks from the radiation. Patient is also on routine pain meds. valium, darvocet and fentanyl patch. She was in pain alot of pain, (crying, shaking, not her normal self) well she has an order for methadone PRN q3hrs. So I gave it to her and I charted on it.

I come in the next night and get my face ripped off by day shift. I get told that this ladies family never wanted her to have it and that they had sent her to the hospital for resp distress and that it was because I gave her methadone. Never mind that they gave her darvocet @ 8am that morning and she didn't go out until that afternoon. So the head nurse tells me that they went through my charting and everything. And I started crying because I felt horrible, But I have no idea if I did anything wrong. The lady was in pain. She had the order and I gave it to her. Everyone that I work with has told me that I didn't do anything wrong and that it's just day shift trying to cover their butts...

What do you guys think??? Am I horrible nurse??? Should I have not given methadone??? :o

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If it was ordered for pain and she was in pain that was not relieved by anything else, then you did the right thing. I get so sick of dying pts having more pain than they need to because THE FAMILY doesn't want them to have the med for whatever reason. Fine, if THE FAMILY doesn't want her to have the methadone for pain, then a representative of THE FAMILY should take her place in that bed and feel what she's feeling.....I bet their minds would be changed REAL quick!

If Admin disciplines you for this, then you need to find another place to work, one that actually cares about their pts/residents.

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Specializes in Cardiac.

If it's on the MAR, and it's appropriate to give it, then you did nothing wrong!

I hate it when the next shift has nothing better to do then criticize the previous shift!

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Specializes in Med/Surg, Ortho.

You gave a medication that was legally prescribed to the patient. If the family didnt want her to have it for some reason,, that should have been passed to you in report or it should have been noted on the MAR that family wants to avoid using this medication, and the doctor should have written for something else.

How do they know it was the methadone anyway,if it was more than a couple hours after you gave it, it more likely wasnt the methadone. MAYBE it is her ILLNESS that caused her SOB?

If she in fact had a reaction to it,, that isnt your fault. It wasnt listed as an allergy and you had no control of what happened after the fact. Except for the fact she needed treatment for resp distress which is why she was in a nursing facility in the first place. She was monitored and she got the treatment she needed. No different than if she would have had a reaction to some new antibiotic they ordered for her.

YOU did nothing wrong in my opinion. You were attempting to make your patient comfortable within the prescribed limits.

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methadone is an extremely long-acting opiate.

repeated doses can result in notable accumulation, prolonging its duration of action and possibly, resulting in adverse effects.

one dose would not have done this.

but it is a drug that requires extremely vigilant monitoring.

initial dosing for opiate-naive pts is 2.5-10mg q 8-12 hrs.

so q3h dosing has its own set of risks and implications.

again, if this is the only dose she got, then it's highly unlikely this caused her resp depression.

unless she has a poa, the family has little to say about this.

darvocet isn't going to do diddly for her pain.

maybe it's time to change her prn to something more appropriate.

methadone is not one of these choices.

leslie

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Specializes in CT ,ICU,CCU,Tele,ED,Hospice.

i agree you did nothing wrong .it was prescribed .the pt shouldn't be in pain because of a family members choice.

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Specializes in ED, ICU, PACU.

Who ordered the medication in the first place-the family or the doctor????? Since when does the family have a say so in the prescribing and administration of medicine for a sick patient? You followed an appropriate order and administered it appropriately. Obviously the patient was in pain or she wouldn't have received the 8AM Darvocet. Seems to me more like the family was looking to capitalize on the patient's situation, rather than showing a genuine concern for a loved one; and, the hospital was trying to pass the buck onto you. Respiratory distress can be caused from a number of reasons with the history you described. I doubt that the methadone had much to do with it because of the time frame. Even if it did, that is the chance that is taken in order to relieve suffering. Why in the world would the family complain about a genuine and sincere attempt to control suffering in their loved one?????

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i'm sorry, cmarie, i never answered your question.

NO, it was not your fault at all!!

if anything, you are to be commended for addressing your pt's pain/suffering.

you have my permission to tell those nurses to eat poop and bark at the moon.

but please, do pursue changing the prn to something else?

mso4, percocet, vicodin....

methadone should not be given prn unless one is inpatient, or is going to be closely monitored.

and good job.

don't let anyone tell you differently.

leslie

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Something tells me that, as an end-stage CA pt, she is not opiate-naive.

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Specializes in icu, er, transplant, case management, ps.

:balloons:

Who ordered the medication in the first place-the family or the doctor????? Since when does the family have a say so in the prescribing and administration of medicine for a sick patient? You followed an appropriate order and administered it appropriately. Obviously the patient was in pain or she wouldn't have received the 8AM Darvocet. Seems to me more like the family was looking to capitalize on the patient's situation, rather than showing a genuine concern for a loved one; and, the hospital was trying to pass the buck onto you. Respiratory distress can be caused from a number of reasons with the history you described. I doubt that the methadone had much to do with it because of the time frame. Even if it did, that is the chance that is taken in order to relieve suffering. Why in the world would the family complain about a genuine and sincere attempt to control suffering in their loved one?????

There are doctors who are afraid of being sued, just as there are hospital administrators fearful of being sued. I don't know if the family was trying to capitalize on the situation. There are families who have some very distorted information about pain management. I've seen them concerned that their dying family member might become addicted. It is an irrational fear but it is their belief. And others are hanging on to the bitter end that somehow their loved one will get better.

I would suggest having a meeting with them and a social worker, explaining the need for adequate pain management and the symptoms they might see. It might have a positive effect and it is worth a try.

Woody:balloons:

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Stand your ground girl! If the docs didnt want it given then it wouldnt of been ordered. If the family doesnt want it given they can take it up with the Dr. so that the order can be DC'd. You will run across this situation more than once in your profession, you gotta learn to stand firm when you know you did the right thing!

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You didnt do anything wrong, make sure you document respirations though when giving it (although if someone is in horrid pain they will be breathing adequately).

Earle58 also hit it on the mark. I get to be a Monday morning quarterback but the doctors are not managing her pain very well. Methadone is a long acting opioid so it really should not be given q 3 hours, there is a high potential that multiple doses would accumulate and really cause cns/resp depression. If the patient is requiring a lot of breakthrough pain medication then they need to look at increasing the Fentanyl patch or starting on another type of pain medication. I also hate Darvocet especially in elderly. For breakthrough pain she should preferably have something like oxycodone (a instant or non delayed formulation).

Also you need to clarify resp distress. If the pt was "struggling" to breathe or rapid respirations then it wasnt due to the methadone. Methadone would cause the respirations to slow.

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