I just started a job in an LTC, closer to home, full time, permanent staff (means I usually will get the same assignment). However I will have to float sometimes, which I actually like. It's alot better than agency, where you get cancelled at a moments notice, and have to travel over an hour to and from work sometimes. Also, financially, I need this job badly, and can't really afford to go back to agency. There-in lies my problem.
I was assigned to a unit other than what will be my "home" unit yesterday. Mostly long-term pt's, but a few just in for rehab. During my last med pass, every, and I mean EVERY one of my pt's was astonished that their med cups didn't contain all the pills they usually get. See, I was giving the meds they were to recieve at the given time, but not automatically giving the prn's for pain, sleep, or anti-anx. All of my pt's were a&ox3, and were aware of what meds they should be getting at what time. I expalined that if they wanted a prn med, to please ask me, and let me know why they wanted it so I could assess, and chart the reason for the prn. Most of them were a bit miffed, to say the least.
I have no problems giving prn's, if and when the pt needs them. However, when I wake a pt up form what appears to be a sound and untroubled sleep to give them their meds, and they request a pain med, a sleeper, and an anti-anx all at once, I have a slight problem. I'm not comfortable with this at all.
I feel as if the facility is failing these pt's, almost turning them into addicts. Some of these people will eventually go home, and will be addicted to these meds one way or another when they do, if they aren't allready. Most have been here more than a month, and take ALL meds, prn and atc, on EVERY shift.
I might add that I'm the only one within the last months MAR to record other actions besides giving the med, such as repositioning, offer of a snack, or any other diversion. Also, when asked, all these pt's rated their pain a "10", which I didn't see in my assessment. They were sleeping or resting quietly, vs wnl, no other s/sx of distress.
I really need this job, and don't want to get canned for not going along with the flow, but by the same token, I don't want my license pulled when state comes in and checks things out, which they're due to in the next month or so.
I tried other interventions, and charted that, but ultimately gave the meds as per pt request. What should I do at this point? Talk to the DON, admin, etc? Like I said, I really don't feel comfortable contributing to addicting pt's, and I really don't feel comfortable unless trying any and all other interventions before a narc. Any suggestions would be greatly appreciated.
Thanks in advance everyone, and may you all have a safe, sane, and love filled holiday!
Also, when asked, all these pt's rated their pain a "10", which I didn't see in my assessment. They were sleeping or resting quietly, vs wnl, no other s/sx of distress.
Pain is what the patient says it is. Bottom line, you have to treat it. Sure, you can try other interventions, and it's commendable of you to do so, but in the end, if the patient is still c/o pain, you have to give that pill.
I usually ask patients to wait a half-hour to an hour after giving a pain pill before I'll give a sleeper or anti-anx myself, and if I'm not comfortable, I don't give it. But document why. Anxiety is something that's perceived only while awake, while pain is not, so I think it'd be OK to document that patient doesn't appear to be anxious since Patient was snoring and roused with difficulty. If someone's BP is hovering below 90 systolic, you might hesitate with good reason before giving Xanax and Ambien with that Percocet.
Last edit by UM Review RN on Dec 18, '06