narcotic policy

My hospital is in the process of reexamining the narcotic policy and I am looking to get input from as many nurses as possible -- please!

We are a 600 bed Midwest hospital and we are trying to write a global policy that will work in all the units of the hospital. The idea is to lump PCA, epidural and IVP narcotics into one policy to cover assessment expectations for vital signs, level of consciousness and quality of respirations. The assessments are to be done ONLY by RN's following a set pattern of q 30 minutes x 4, q h x 4, q 2 h x 2 then q 4 h thereafter until all narcotics are stopped. The time of the first assessment to be at the initiation of dosing and restarts at the beginning with ALL dosing increases. As a Med-Surg unit, we do not have non-invasive methods for vital signs and the only way to assess LOC or quality of respirations is to talk to people. I don't see this as a huge issue with the PCA and epidurals because we don't change the rates very often but IVP is completely different. Our doctors usually give us a range [e.g. Dilaudid 0.5 - 2.0 mg IVP] and let us use nursing judgment to achieve pain control. With this new policy, if I don't start everybody at the max dose, I will be restarting the protocol each time I increase the dose -- this is intrusive enough during the day but is going to be really annoying at night. How would you like it if your nurse gives you something for pain and then wakes you up every 30 minutes to ask if you know where you are? And, if I wean you down then you go to PT and have pain, I restart at the beginning again if I up the dose -- even if it is just one time.

Additionally, we still have a few LPN's at our hospital and they are really fantastic nurses. We already have a policy against LPN's doing IVP drugs, but this policy goes even further and wouldn't even let them do the assessments or take vital signs! Is this really something they aren't qualified to do?

I know there has to be a better way and a better idea in use at other hospitals -- please share your hospital's policy!