MD ordered placebo for pain PRN~would you give it?

[beetlebailey524]

I am an RN student who will graduate in May. I ran across a situation during my clinical the other day that I wanted to seek some experienced advice on. This was my 3rd or 4th day of clinical at this hospital so I was still getting oriented to everything and trying to familiarize myself with all the "policies and procedures."

I do not have an instructor with me but my preceptor is great and always answers my questions but even she seemed to be at a loss of explanation for this one.

The secretary for the floor asked my preceptor to try and decipher an order for a new med scribbled out on the pts chart so it could be ordered. It was determined to read "Placebo for pain PRN" and scanned to the pharmacy. So of course I had to ask my preceptor if this was normally done at this hospital and what exactly would be given to the patient.

She did not seem to surprised by the order and said she had not ever had this ordered for any of her patients so she did not know what would be given. (she was acting as charge nurse so we had to view the chart)

Being new and a student and not knowing the entire situation I did not say anything else to her but I did ask another nurse what her opinion of giving a placebo for pain was. She seemed surprised that this was actually written on an order and scanned to the pharmacy but also said she had never had this ordered for any of her patients before so she really did not know what to tell me.

All I want to know is this something that goes on and nurses are doing? I would not give a placebo pain med to a patient, ordered or not. It is not honest and goes against all I have been taught in school about an RN being a patient advocate, practicing with fidelity and non-maleficence. Am I just being naive?

If the patient were to find out they had been mislead and wanted to press charges against the MD, the hospital and the nurse wouldn't that qualify as an intentional tort on my part-as my instructor always says "a prudent nurse would have known otherwise!"

I do not know if the order was ever carried out but I was told the doctor had discussed this with the patient's nurse. Whatever that meant? I have chosen to use this as an ethical dilemma I encountered during clinical to write a short paper on so any feedback would be appreciated, pro or con.

Thanks.

[RN Randy]

What's hard, addicts are made not born. If it requires alot of drugs to take care of their pain, it's not their fault.

[\QUOTE]

This is not, and never was, at dispute.. [the first part].... On the second part, again; a perfect example. Sorry, but people can most certainly dig themselves into a hole without your help. Addicts don't come to the ER for drugs. Addicts end up in the ER for lack of money or supply outside of the ER. But again, addiction isn't the issue here.

It's obvious when a statement is made "about the long and liberal thread, and the pain face being equal to the withdrawal face" we have a difference of opinion, regardless of the point of that fact sometimes being true.

Sorry, then. Let's just call them all the "I'm suffering" face. And Sometimes? When is withdrawl not.. at the least.. uncomfortable? What bugs me here is the hipocracy...

The only way to stop withdrawl pain [in the mind of the addict] is to administer the required substance.

Or is it? So... suffer through or get the drug... You patient says he's having 10/10 pain... quick, grab your narcs before he loses consciousness...

Thus far, Several people have posted as witness to placebo effectiveness....

Oh, that's right.. I was responding to a question about a placebo being useful or ethical... how did we get here? Again?

Everyone seeking relief is not an addict. Everyone seeking relief may be dependent, but not an addict. Everyone seeking relief may be an addict, but need relief. Regardless of the person's status: the shared need is relief!

... And here, you are correct, we part ways like celebrity divorce. Dependancy doesn't equal addiction? Sorry, but that's about as clear as mud. HOWEVER; you make my point crystal clear; the need is relief.... and if a placebo relieves... GAME OVER.

If time were available for our patients, if alternative medicine and biofeedback were available, if the best technology were available,IF......(FILL IN THE BLANK) were available for pain relief...available to those across the economic spectrum.....available regardless of education, or part of the country.....

..... we would STILL have seekers.

HOWEVER, it isn't and doctors and hospitals continue to throw the magic pills without backup, counseling or other management techniques to help their patients. They don't give people realistic expectations for lifelong pain, and the system IS BROKEN.

.... nothing to argue here except that the ethical use of placebo's is the topic, once again, not addiction and defense of drug dependancy.

and that there is even a discussion about placebos or that any doctor would order the provider who is to be most trusted and the patient's advocate to violate that same patient's trust.

Finally, the point. And yep, we disagree. I said, and will always say, start at the bottom and work your way up. Saline and M&M's can save lives if the recipient believes they are life-saving. Yet another reason I prefer the DO over the MD, but that's another topic too, isn't it? And for violating trust...? The pt trusts me to fix the problem. If I do [whatever] to fix the problem, where's the violaton? So I guess you've never told a patient in trouble that "Everything will be alright."?? I know you have; and my question is, who the heck do you think you are???? You don't know that, and you can't promise that. [reference your own comment about being the Almighty] Talk about violation of trust.

That's like you saying "I would *never* steal."

Sure you would. You just haven't been presented with the right circumstances to rationalize your decision.

Anyway, we all have to do what we think is right, believe what we do is right and live with those thoughts and actions daily.

Holy moly... I agree! haha.

rb

[MAISY, RN-ER, BSN, RN]

To each their own. I have nothing else to add, I believe it's all been said.

M

[Southernurse]

unless "placebo" is the name of a new drug, the order does not include the 5 (or 6) "rights". there is no drug name, no dose, no time, no mode of administration...you get it. i don't understand why if it was scanned to the phcy that they even knew what to send to the floor. the order is moot and i would have called the md and got an order for an actual drug with the correct guidelines. otherwise, without all the correct info, it would be out of scope of practice to "pick" a placebo to give and guess a dose and proper interval of administration. no one could possibly fault any nurse for not following such an order. md is having a bad day.

[StrbryJelo]

MAISY, RN-ER I agree with RandyRN. And I disagree with you that we've made the addicts and seekers. I think medicine has become an enabler, but we didn't make them. They make themselves for what ever reasons. In the past they would turn to ETOH and street drugs. Now, it's easy to get Rx narcs. I've also given placebos, but it's been a long time ago. Another long discussion I'm not up to at this time as to why the pt. was ordered a placebo. It worked. Pt was happy and quite comfortable. I have no problem with trying a placebo when appropriate. If it works fine. If not, then you move on to something else.

[MAISY, RN-ER, BSN, RN]

:wink2:Good thing I fly to Florida now instead of drive, two less chances to make it to your ERs.

As for making addicts everyone has their own opinions. All I know is that we are handing 1mg iv dilaudid out like candy. 1mg dilaudid=7.5mg morphine so, how is it we have 21yo SCC needing 20-30 mg iv dilaudid? They didn't get that on the street, it was prescribed as they were enabled to leave the world and become what they become-frequent flyers. Same goes for those chronic anythings that come to the ER.

Again, to each their own. Do alternatives work? We know they do....but pain exists, and whatever meds work should be used. Not for me to judge another, or for you-placebos have no place at all for people in pain or in a hospital environment.

M

[LilyBlue]

I agree that physicians have made a lot of the addicts. I am absolutely certain that some dose them high and leave them high to avoid late night calls on behalf of the patients who would never report pain relief, even if damn near dead from opiate respiratory depression.

[leit29]

heya, im currently doing an assignment which revolves around the administration of the placebo. i do agree that it is not an ethical option to administer the placebo as it doesnt guaruntee relief from pain but...it is requested as PRN. therefore noting that the patient can ask for it if he or she wishes to. In saying that, if its documented on a patients chart then it is approved by the doctor. in my opinion, i think its ok?...

[madalene23]

You are absolutely right on this! I would never give a placebo to a patient. I am a firm believer in patient's rights and I feel that only the patient knows the amount of pain they are in. To give a patient a placebo would be like saying, hey I know you say you are in pain, but I don't believe you... Not gonna happen! Good job at being an advocate for your patient!