Too Many Pain Meds!!

  1. 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.....
    Last edit by nursebrandie28 on Feb 23, '07
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  2. 16 Comments

  3. by   AlbertaBlue
    If you feel strongly that the doctor is not practicing ethically then perhaps you could approach your Ethics Board. The last time I disagreed with the care plan proposed for a dementia patient on our unit, several of the nurses on our unit approached our manager, and we submitted the case for an ethics review. It was very helpful and everybody seemed to benefit from the process - and because there was an objective mediator everyone was able to voice their opinion. It sounds to me that for a patient who normally takes a nominal amount of pain medication, the amount that you were ordered to administer was too much (especially since she had been there before and left AMA). Ethics review boards handle cases like these really well. Take it easy.
  4. by   nursebrandie28
    I thought about the Ethics board, however, at this particular hospital, THERE IS NO ETHICS BOARD. So I have been thinking about writing to the board of administration!!!

    I just sometimes feel like a legalized drug dealer. I don't mean to be so blunt, but I do.
  5. by   SCRN1
    You could report him to the Medical Board of Examiners and let them take it from there.
  6. by   AlbertaBlue
    I appreciate your frustration...I sometimes carry out orders that I have questioned only to be told that I should do as ordered...I can't believe that your hospital doesn't have an Ethics Board! Would you feel comfortable going to your manager with your concern and telling her/him that you would like to take your issue further? It would be a shame for you to carry your concern forward without your manager's support - there is nothing worse than pursuing something as significant as this without someone else's support.
  7. by   lorster
    what i don't understand is how these people can come in and get this much medication and then the next thing you know, the pizza delivery guy is showing up at the nurses station to deliver the patient the pizzas and drinks he orders for him and all his friends who are with him. I'm personally tired of medicating these clowns which takes a great percentage of my time when I have other, more ill patients to tend to. I think this subjective, pain scale is for the birds and absolutely hate even asking a number because the numbers are usually way out of the 1 to 10 range. At some point it becomes unassessable. These patients get their dilaudid fix and then run out to the patio to smoke and visit all the other narc seekers. Sorry folks, I have become the nurse I never wanted to be like. I see it all very clearly. Its all a big money game where our doctors are pulling down six figures and these patients are doing a great job of sucking the system dry. I am the one at the bedside, running my a$$ end off so I can get all the ridiculous work done that the docors have overkilled, ordering. I guess I'm one of the burned out and ready for the road. Sorry.
  8. by   TazziRN
    My God.......and the pt was still coherent??? I'm an addict in recovery and I don't think I could have handled that much!!

    I worked with a Dr. Feelgood years ago....kep ordering Demerol for a pt who claimed to be in such severe pain. I was not comfortable with the amount ordered and refused to give it. I pulled it up and handed it to the doc and told him to give it. He did.
  9. by   nursebrandie28
    Quote from SCRN1
    You could report him to the Medical Board of Examiners and let them take it from there.

    How would report one report somebody to the medical board of examiners?
    Have you or anybody else done this?
  10. by   AlbertaBlue
    I love this submission! I do mean this with the utmost respect...and I do appreciate your frustration...but I found it an hilarious posting...you have a wonderful way with words! You should write comedy skits for nursing! And honestly...I really mean it...I'm just laughing at the truth behind your words. I don't want to diminish your point because you make an excellent one...but really...that was great!
    Quote from lorster
    what i don't understand is how these people can come in and get this much medication and then the next thing you know, the pizza delivery guy is showing up at the nurses station to deliver the patient the pizzas and drinks he orders for him and all his friends who are with him. I'm personally tired of medicating these clowns which takes a great percentage of my time when I have other, more ill patients to tend to. I think this subjective, pain scale is for the birds and absolutely hate even asking a number because the numbers are usually way out of the 1 to 10 range. At some point it becomes unassessable. These patients get their dilaudid fix and then run out to the patio to smoke and visit all the other narc seekers. Sorry folks, I have become the nurse I never wanted to be like. I see it all very clearly. Its all a big money game where our doctors are pulling down six figures and these patients are doing a great job of sucking the system dry. I am the one at the bedside, running my a$$ end off so I can get all the ridiculous work done that the docors have overkilled, ordering. I guess I'm one of the burned out and ready for the road. Sorry.
  11. by   nursebrandie28
    Quote from lorster
    what i don't understand is how these people can come in and get this much medication and then the next thing you know, the pizza delivery guy is showing up at the nurses station to deliver the patient the pizzas and drinks he orders for him and all his friends who are with him. I'm personally tired of medicating these clowns which takes a great percentage of my time when I have other, more ill patients to tend to. I think this subjective, pain scale is for the birds and absolutely hate even asking a number because the numbers are usually way out of the 1 to 10 range. At some point it becomes unassessable. These patients get their dilaudid fix and then run out to the patio to smoke and visit all the other narc seekers. Sorry folks, I have become the nurse I never wanted to be like. I see it all very clearly. Its all a big money game where our doctors are pulling down six figures and these patients are doing a great job of sucking the system dry. I am the one at the bedside, running my a$$ end off so I can get all the ridiculous work done that the docors have overkilled, ordering. I guess I'm one of the burned out and ready for the road. Sorry.

    I feel for you, I turned in my resignation because this doctor, in my opinion, is going to kill somebody!!!
  12. by   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.
    Last edit by Myxel67 on Feb 23, '07
  13. by   nursebrandie28
    I suggest topamax, benadryl, reglan.....most doctors will try it first, then move on to the narcs.....nope not this doctor!!!! He goes straight for the demerols, dilauded and stadol!!!!

    which is funny because all three of those meds have headaches as a side effect!!!!
  14. by   fultzymom
    I have a patient who Q4HR gets Dilaudid 2 mg et Phenergan 50 mg IVP. What does she have wrong? Diabetic gastroparesis. Now correct me if I am wrong, but doesn't Phenergan slow down the GI tract? And Dilaudid has nausea et vomiting for a side effect. Besides the fact that 50 mg of Phenergan Q4HR is a lot! And this woman walks aroung perfectly fine she is so used to it. If she doesn't get it, she breaks out in a cold sweat et gets red, blotchy spots on her neck!! I hate giving it to her! I am waiting on the time that she codes on me or something.

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