Too Many Pain Meds!! - page 2

Hello Fellow nurses, I have a question/vent/comment. There is a doctor in ER at one of the many places that I work. He is notorious for giving pain medicines. People come from over 20 minute... Read More

  1. by   Indy
    We had a lady about a month ago, who developed her first migraine in the ER after getting NTG for her chest pain. It took the following to get her some relief: morphine and tylenol (in the er), percocet, ultram, toradol (one at a time with 45 mins or so between each one to judge effect) once she got to the floor. At this point I was ready to cry just watching the poor gal. She's huddled on her bed in a fetal position, tense as can be, crying in the dark. I asked for demerol and phenergan on the recommendation of a coworker, and got it ordered. I'll be darned if it didn't do the trick. I told her to see her family doc after the chest pain workup and ask for migraine meds, and of course, to never EVER take NTG again.

    She's the most miserable example I've seen yet. It did help me somewhat, to finally see a patient that was in complete need of any and all help we could provide. We do have our bunch of frequent flyers who can wear me down a bit, but fortunately no docs at the moment who stand out as overmedicating. If anything, I have to call for pain meds more often now with the new hospitalists.
  2. by   Jolie
    Quote from nursebrandie28
    Hello Fellow nurses,

    I have a question/vent/comment.

    There is a doctor in ER at one of the many places that I work. He is notorious for giving pain medicines. People come from over 20 minute drives just to see him. Whenever I work with this particular doctors we get the same patients "frequent flyers" over and over for migraine and/or back pain.

    Well, normally I am not against giving pain medicines, I am the patients advocate and pain is subjective. Totally understand this concept. However, the other night for a migraine headache (hx of migraines) that was seen Monday night, Wednesday Night and now tonight (Thursday) all for the same complaint, received full work ups all three nights, this doctor ordered......
    (and at home, she had taken 2 percocet, 2 darvon)

    All IM:
    100mg demoral
    2mg dilaudid
    10mg valium
    60mg toradol
    50mg phenergan
    2mg stadol

    and exactly 20 minutes after her last shot, her pain medicine (stadol) she got up and signed out AMA.....


    Now, this is not an uncommon practice. So now here is my questions....Is this too much? and can I legally NOT give it, if I feel it is unsafe for the patient. This particular patient had stable VS after every shot.

    When I addressed this to my nurse manager, she said that this doctor is being looked into and that if a patient thinks that pain is not being treated they can sue.....how true is that? i mean, should we just give the whole NARC box to satisfy pain?

    Open for comments.....

    I understand and share your frustration, especially given the frequent-flier status of this patient. I agree with Tazzi who recommended insisting that the doctor administer medications that seem excessive to you, as no doubt, if the patient experiences a respiratory arrest, you will be hauled into court and before the licensing board for failing to question an inappropriate order.

    I also question whether this doctor ever makes referrals to a headache clinic or pain management specialist for patients like this. If he is truly interested in helping a patient, and believes that the patient is experiencing pain due to a legitimate condition, why not help that patient to get long-term assistance?
  3. by   TazziRN
    Quote from Myxel67
    I do believe in the need for effective pain control, and it's not the nurse's job to detox or save someone from what is perceived to be a pts addiction. People who use narcotics for pain control do develop a tolerance so it takes more to relieve the pain. You did say that all the meds were ordered IM. Many drug seekers would beg for IV, so perhaps there is a method to the doc's madness.

    If the pt returns, you might mention Topamax. Its an antiseizure mededication that has been used effectively to treat migraine H/A.

    The worst pain you've ever had is the one you're having at the moment.

    Someone who orders a pizza delivered to the ER is not in that much pain, I'm sorry. Yes, I know that pain is whatever the pt feels and that some can be very stoic in the face of severe pain, but in this day and age we have created a lot of addicts. It's pretty obvious in this scenario when the pt only seems to come to the ER when Dr. Feelgood's cousin is on duty. It is not our job to detox someone, but it's not our job to feed the addiction either.
  4. by   nursebrandie28
    Quote from TazziRN
    Someone who orders a pizza delivered to the ER is not in that much pain, I'm sorry. Yes, I know that pain is whatever the pt feels and that some can be very stoic in the face of severe pain, but in this day and age we have created a lot of addicts. It's pretty obvious in this scenario when the pt only seems to come to the ER when Dr. Feelgood's cousin is on duty. It is not our job to detox someone, but it's not our job to feed the addiction either.

    I totally agree, I think sometimes we create addicts. I think a pain level of 0 ALL THE TIME, is unrealistic. I hate to sound mean, but the ANA and AMA need to get on board about putting restrictions on ALL these pain meds!!!

    I quit this job because of this doctor!!

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