LTC Drug Addicts - page 3
Has anyone else ever worked with LTC residents that were on a lot of pain medications but it was not clear why they were being given them regularely? I hope I worded that right...I'll explain... ... Read More
Jun 10, '03Speaking of undermedicating res.... A few yrs back had a 95yr old little lady with Breast Ca with a malignant mass that was just the nastiest wound I have ever seen..... came in to work one day res took a turn for the worse and was in sooooo much pain. Guess what she had ordered? Tylenol 1000mg!!! I immediatly called the md..he stated "she has Dementia and her wound isn't painful she doesn't need anything..I just saw her yesterday... I hit the roof he refused to give me anything.. asked him if maybe the Board of Health would be interested in this case.....Well, I got an order for MSIR and oxycontin really quick..... What gives with some of these MDs?
Another question how does culture/ ethnicity affect pain perception?
Jun 11, '03Check out.
Jun 11, '03gizzy76, I do not at all mean to come across nasty or snide so please do not take it that way. In My state anyway you would be violating the residents rights to force her to go to the dinning room for her meals if she is of sound mind and prefers to eat in her room that is her right. In my state we also have 1hr either way in giving meds another words if med is ordered @ 4pm then we have from 3pm to 5pm to get them there meds. Now this does not in anyway mean we can purposely withhold giving meds in a timely manner. It is there because we usually have rather large med passes and could not accomodate every res getting their meds right at 4pm. Obviously this women should get her meds in a timely manner but she needs to understand that she is not the only res you are caring for. I understand your postion been there myself it is not easy but you just have to be careful that you do not violate their rights. Good luck with your resident.
Jun 11, '03AngelBear - I realize that yes, maybe it could be a violation of rights, but I discussed the matter with the Site Manager of our unit and she was in complete agreement with me about this woman coming for meal times. Also, it is policy in our facility and this woman is quite aware of that. Thanks for the well-wishing with this resident. I'm sure she would be a very pleasant woman had she not been spoiled rotten her whole life. Deep down I kind of feel sorry for her.
Jun 11, '03I currently work in a county run facility(call it the poor house) and residents seem to have less rights there.In my experience in private ltc's in this area if an a&o residents wants to eat in their room there really is no question-Without those people in those beds we would be without jobs and the staff accomodates within reason...it is their home and we really work for them.I really don't see a problem with starting the med pass with her when she is in her room-I don't think that is an unreasonable request as she has her pain controlled on this strict schedule-who knows what can happen while you are passing meds in the d/r that can hold you up?A fall,a choking episode or even a death in the soup(not fun) I don't know what type of facility you work in but it sounds like your site manager and some of your co-workers see the residents special needs as inconveniences.I can imagine what it must be like to live in an LTC and be dependent on others....and years of chronic pain must effect the personality-as does any illness and just being in an institution...If you are lying in bed and can not get up without assistance I imagine it is easy to focus on your own problems and try to control the few aspects of your life that you still can.Do you think that maybe this is part of what she is doing? I can't say that I would act any differently if I were in her shoes.I know a woman in her early 60's-was working just a few months ago -and is now in our LTC-food is a major problem for her.She almost always requests the cold lunch and then when she sees what others have she changes her mind and the staff are aggravated with her and want to stop her behavior.My simple solution is-order the hot plate everyday and if she does not like it we can substitute a sandwich-we keep an array on each unit.By trying to deliver an ultimatum to her the staff escalates the situation and she ends up in tears and the whole d/r is in an uproar...Why? Cut her a break-look at her life....We try to make the residents in LTC be little round pegs each fitting nicely in their little round hole-we don't like the school doing that to our children-why are our elders treated any differently? I don't know-I hope I am never dependent on others or demented......Imagine how they must feel....I know when I was younger I had a different perspective and a lot less patience but my yrs of experience have changed me.....As I get older it gets way easier to see myself in one of those beds....and I have lost my parents,too.I don't know what exactly changed my attitude and I would love to say something here that would get across to you exactly what I mean...I hope I am not coming across holier then thou because I am NOT that...I b*tch and moan my share every day...but I do try hard-and some days it is harder then others....
Jun 11, '03Good post ktwlpn
We must never forget the individual - it is very hard and we in LTC/ nursing home /hostels (I use these words as that is what they are reffrred to here) have heavy work loads and often people who do not have a lot of training in behavourial management - It gets back - to peoples rights. their dignity and their individuality -
We had a very similar resident who never ate in the dining room - for a couple of reasons - (she too was mentally alert) - she was embarrased by the fact that she might occasionally spill her food and that managing the knife and fork etc showed everyone in the world that she was becoming dependent and disabled-
Yes she was a very proud and spoilt lady - never had children - always had the comforts - She also did not want to sit in the dining room with others, as she couldnt eat with the noise of the other residents and she didnt like to look at other people who required assiatnce (feeding) with their meals - it made her aware of her own vunerability
We had a number of issues with this woman and a lot of the staff had a lot of trouble caring for her - Good luck with your lady -
I guess an alternative view is that at least she has the spunk to say what she wants and expects and wouldnt we all like to think that her age we would have our say and expect the best for ourselves
However that dosent make it easier does it
Cheers TookieLast edit by Tookie on Jun 11, '03
Jun 12, '03>>>>>>>>>>>>>>>>>>>>Yes she was a very proud and spoilt lady - never had children - always had the comforts - She also did not want to sit in the dining room with others, as she couldnt eat with the noise of the other residents and she didnt like to look at other people who required assiatnce (feeding) with their meals - it made her aware of her own vunerability
We had a number of issues with this woman and a lot of the staff had a lot of trouble caring for her >>>>>>>>>>>>>>>>>>>>>>> How was your resident handled,Tookie? I imagine that I would not want to eat out around people if I could not feed myself without problems.And it is so common for higher functioning residents to be uncomfortable around the lower functioning for many reasons.I really think the "old days" before case mix in LTC was better especially for the alert and oriented.Verbal abuse between these residents is very common,too.We have a&o residents in rooms with trachs....(we don't have many private rooms) I go home with my nerves on edge after listening to a screamer for 8 hours-I can't imagine living with it 24/7.I think that the type of residents we are talking about here require us to look past the pain issue to the deeper causes for their behaviors-It can be as simple as gaining trust-If you say you will bring the meds at a certain time then you should...If you don't then the resident sits there worrying and getting more uptight by the minute which causes more pain and makes the pain med less effective when she does get it...
Jun 17, '03psych sounds like a good idea for your resident... she is on too many meds... pharmacy consultant should make request for the dr to justify all of the need... duragesic patch may not really be the answer... seems that if the pain is real.. and remember.. she is feeling it..not us... the ms contin is the way to go for more regular control with roxinol for breakthrough pain.. she probably needs to detox and start fresh... and the dr that started this... should be shot!!!..sorry..
Jun 17, '03my last reply went to the wrong thread i think.. anyway.. it was said earlier that the residents are in long term care and are going to die anyway.. i agree with this but to a point.. the patient in question is only 67 y/o.. she still has a long time to live.. i also have chronic back pain... i went through the chymopapane injection yrs ago that failed.. i have 2 discs in my neck.. one at t2 and one at l5.. so ... i know pain.. i didn't work for yrs. because of it.. now.. i work as don at a long term care facility... i do understand pain.. we do pain management and do it well.. however.. 67 is toooo young... to be so addicted.. she needs help to control the pain.. to live with it and deal with it... let her control the pain rather then the other way round.. i am in pain daily.. right now my hips are killing me.. but.. i KNOW that i can't work if i use anything.. so.. i deal with it.. we need to work with our residents to help them through the tough times... psych is a good start..
Jun 17, '03Wow...this is a great thread and I must add my 2 cents worth...I know nurses who will RUN down the hall to give an Ativan or Xanax to a patient who is simply talking too much for their liking,but who would make someone waits hours(literally) for a pain med. Makes me really angry!!!Grrrrr!
Jun 17, '03Originally posted by kathi yudin
my last reply went to the wrong thread i think.. anyway.. it was said earlier that the residents are in long term care and are going to die anyway.. i agree with this but to a point.. the patient in question is only 67 y/o.. she still has a long time to live.. i also have chronic back pain... i went through the chymopapane injection yrs ago that failed.. i have 2 discs in my neck.. one at t2 and one at l5.. so ... i know pain.. i didn't work for yrs. because of it.. now.. i work as don at a long term care facility... i do understand pain.. we do pain management and do it well.. however.. 67 is toooo young... to be so addicted.. she needs help to control the pain.. to live with it and deal with it... let her control the pain rather then the other way round.. i am in pain daily.. right now my hips are killing me.. but.. i KNOW that i can't work if i use anything.. so.. i deal with it.. we need to work with our residents to help them through the tough times... psych is a good start..
For some people, "pain mgmt" means "learning how to suck it up and live with the pain." This is not true, and good pain mgmt professionals will be the first to say so. It is contrary to all of the current pain mgmt literature/information. I'm not even going to get into the "addiction" comment...addiction rarely happens when there is pain, and there is plenty of research to back that up.
It saddens me when I see comments like the ones quoted. It just goes to show that there are still a lot of nurses and doctors out there who need re-education on this issue. We cannot allow our personal prejudices to influence our care.
Jun 17, '03"I guess my biggest part of the post was wondering why doctors just accomodate these requests and not give her a pain patch then? "
My understanding from a hospice perspective on the patch is that they are expensive, difficult to titrate and may be more appropriate for some patients who are home care and have a difficult time understanding administration and dosing of other meds. MS contin is cheaper and better, easier to titrate and therefore more appropriate if there are no MSO4 allergies. Oxycontin is expensive. As a pharmacist told us recently, "it is neither unethical or unrealistic to examine the cost of pain medication when considering an appropriate drug."
Jun 18, '03Thanks again for the great replies...I've worked with this woman more over the past week and have tried to open my mind more to her needs and issues. In fact, I even approached her yesterday in regards to a duragesic patch. She said that it was discussed with her doctor previously and he felt it would not be suitable for her in controlling her pain. I left it at that. She also said that her nightly 1 mg injection of morphine is sufficient to control her breakthru pain until 0500hrs when her 40mg of oxycontin is due.
Hate to do it...but I have to throw this in, in regards to this woman...
Some of our residents help fold the facecloths that come back in a sack from laundry. She was asked the other night if she would mind to help and she got all snotty and said,
"No, I'm NOT doing that, I'M retired!" And she was completely serious.
Some people are too much. Personally, I would have enjoyed the change of routine from sitting in my lounge chair continually watching television all day.Last edit by gizzy76 on Jun 18, '03