When family refuses IV pain meds for cancer pt...? - page 4

What do you do when a pt's spouse refuses to allow you to administer IV pain medications as ordered? Pt has end stage cancer w/ brain mets. DNR. Confused most of the time. Has not been deemed incompetent, has no power of... Read More

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    As others have pointed out as long as the spouse hasn't been appointed power of attorney he really doesn't have a say. Of course he can yell at you till he's blue in the face for giving pain meds..but that's a price I'd be willing to be pay. UNTIL and WHEN HE is the one with the power of attorney he can't legally do anything to you(being yelled at of course is not what you want but the spouse is not your patient). I would DEFINITELY go to the MD for an order for a fentanyl patch...when my father was dying of pancreatic cancer(and I don't need to tell a bunch of people in medical profession how painful and NASTY pancreatic cancer is) those fentanyl patches kept him more comfortable than anything given through an IV. For BTP we would mash up 30mg oxycodone pills in applesauce(which he didn't need that often as the Fent patch did a great job). Of course every patient is different and what worked for my dad may not work for your patient.

    As for your patient's doctor..go to the chair of oncology if you need a pain management/palliative care consult. It sounds like you're patient really could benefit from a daily visit from pain management/palliative care...it also sounds like she needs a long acting narcotic on board.
    canoehead, nrsang97, GrnTea, and 2 others like this.

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  2. 1
    Quote from DidiRN
    Do you guys think contacting Adult Protective Services would be worthwhile? I'm not real familiar with all that they do, but wondered if this would be an option.
    Not only worthwhile, but mandatory where I come from.
    GrnTea likes this.
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    devil's advocate....he will out live her, and he will be filling out the press ganey form. also, the dead don't sue, but the living do.
    dishes, PMFB-RN, and Esme12 like this.
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    Quote from morte
    devil's advocate....he will out live her, and he will be filling out the press ganey form. also, the dead don't sue, but the living do.
    His survey is the least of my concerns...
    What do you feel he could he sue for?
    DizzyLizzyNurse, wooh, and GrnTea like this.
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    does the spouse have the legal right to speak for the patient? You need to get others involved and STAT. There is no reason to allow someone to die in agony
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    Quote from helloberry
    His survey is the least of my concerns...
    What do you feel he could he sue for?
    morte was being facetious.....hospitals press ganey surveys are the facilities bible these days.....sad.

    He could sue for anything that will cost the hospital time and money....not that he would win. Forcing a patient to take a med she doesn't want...(her saying no no no no all the time) is assault. Now we all know she is confused and is in pain but that doesn't mean he can't sue later just to cause a stink.

    People are crazy....and do weird things.

    For example.....I had a patient that survived a horrible fire and lengthy hospital stay and sued for a breakdown over the right ear for O2 tubing.....it wasn't bad never needed plastic surgery like their burns...but it did get red and blister. He got a settlement from the facility. It never went to court.
    canoehead, jadelpn, and applewhitern like this.
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    Question...

    The patient denies being in pain even though she is showing signs of being in pain. The husband does not want her medicated. Could this be an issue of culture instead of allowing a patient to suffer?
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    Is she saying she isn't in pain when the husband is there? Do you have a CNS to get involved also? If he is NOT her POA then she should be medicated when necessary! You need to be the squeaky wheel if no one else will! Are there any children that visit? If so I would involve them and call a family meeting. If her doc isn't doing anything then go up that chain too.
    GrnTea likes this.
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    Quote from helloberry
    His survey is the least of my concerns...
    What do you feel he could he sue for?
    People are strage.....and can sue for anything. I would NOT take this on myself.
    And I am curious as to why all of the concern about the husband when he is not your patient? He has no power as of yet (or if at all per a POA or HCP deems someone else) and I just don't understand that part of the equation at all.
    OCNRN63 likes this.
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    Quote from Esme12
    morte was being facetious.....hospitals press ganey surveys are the facilities bible these days.....sad.

    He could sue for anything that will cost the hospital time and money....not that he would win. Forcing a patient to take a med she doesn't want...(her saying no no no no all the time) is assault. Now we all know she is confused and is in pain but that doesn't mean he can't sue later just to cause a stink.

    People are crazy....and do weird things.

    For example.....I had a patient that survived a horrible fire and lengthy hospital stay and sued for a breakdown over the right ear for O2 tubing.....it wasn't bad never needed plastic surgery like their burns...but it did get red and blister. He got a settlement from the facility. It never went to court.
    That's good info... I was worried that I had already done something that may invite a law suit! The spouse is kinda crazy... SUPER attentive when staff are present- rubbing her feet & talking sweet, singing to her- but when we aren't in the room he sits in the corner & ignores her. We have observation type windows where we can see into the room without disturbing the pt, so I've noticed this frequently. Now that I think about it, I've actually never seen him showing her any attention when we weren't in the room... But then again, my 4 seconds 4 times an hour is hardly a good judge of what they do the rest of the time.

    I don't feel like its a cultural/religious thing- they're southern baptist just like most of the staff. Even used to go to church with one of our CNAs. It feels more like a control issue to me, sadly.


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