Quote from OrganizedChaos
I just didn't want to give out too much info.
Lol. Oh well! Yeah, I felt it did too. Apparently the doctor didn't believe so. Then to have the doctor tell me to NOT call a code?! Excuse me?! Hell no! ESPECIALLY after he JUST laid eyes on her and did NOTHING!!!! That was MY patient and that is MY license. If he likes to dangle his license over the edge like that, cool beans. I don't. I hope he has good insurance. Because if *I* found out he rounded on MY family member & did nothing, I would be none too pleased.
1). you've got to chill down. Seriously.
2). you've got to stop getting into that psychology of patient's ownership. It doesn't help anyone. You're all working together, whether you like it or not.
3). as your facility doesn't seem to have it, you have to make your own "patient's checklist" and use them. Everyone on any dose of opioids => standing order for Narcan. Everyone with DM => standing order for IV dextrose. Everyone on tele without renal failure => replacement protocols for lytes, etc. Correct as needed according to your local policies and what your RNs are doing. If checklist is not complete, ask for orders as soon as possible. It will save a lot of nerves and trouble for everyone.
4) and the main in the situation described: only one part of neuro assessment which is legible for a patient on high or escalating dose of opioids is respiratory drive (basically, RR plus air entry), which can define "code blue" (acute CPR) but not stroke code. Everything else, including complete neuro exam, must be done after Narcan. It takes only 2 to 5 min to work in full. "Time is brain" is said about a person who suddenly fell in shopping mall and cannot speak, not about someone on dilaudid Q2 IV.
The Q2h frequency is borderline for IV hydromorphone as its T1/2c is 2.3 h under ideal condition. It means that if it is given strictly every 2 hours, every next dose "catches the tail" of action of the previous one. Early or later, it inevitably leads to building up and overdose even in a person with perfectly functional liver and kidneys. Literally everything that might go wrong with human body makes this effect worse.
5). You are a nurse (yeah, I remember you're LPN but you're still a nurse), and you went through school and were given autonomy for a reason. Your job is not to "get doctor to do something". Your job is to access (repeat as needed) and think (repeat as needed as well) and become a nurse whom providers trust as themselves. A nurse about whom they know - if she calls, drop everything and get there.
Sorry if that is not what you would like to hear but I have experience of being on both sides of the line.