Why do I feel like I'm doping my patients?

[MikeyBSN]

I don't know if this is just where I'm doing my clinicals or if other students and nurses have noticed this but does anyone feel like they end up "doping" their patients when they come on because the previous nurses haven't given them anything? I got a patient the other day and she had nausea, pain, fever, the works, she was complaining, vomitting and in pain. I looked at the medex and she was getting regular medication for the stuff on schedule, but she also had a bunch of PRN meds ordered. She had Zofran for nausea, morphine and pecocet for pain and tylenol for fever, and all the spaces next to them were blank. No one had ever given her any of her PRN meds, so I gave them to her. I felt like I was doping her up though. This isn't the first time this has happened. Is there a reason nurses don't give patients all their PRN meds? Has anyone else experienced this?

[Bipley]

I agree!!! I handle meds for alot of hospice patients and it burns me when I walk into report and hear the patient has been pain free all night then I go into the room and he has increased SOB, grimicing and facial frowning. LAWD , I spend all day getting the patient comfortable again.. Which is not my complaint but if the patient had been medicated properly it would have saved the patient alot of undue pain and anxiety.

I have to post one of those "personal experience" stories. It just explains my point well.

My Dad had terminal colon CA, he died 4/26/05. When I flew home to say my good bye's I knew it was the last time we would *really* be able to talk but honestly, I didn't think I was going to be attending a funeral as well.

I got home and I found my Dad suffering. His vitals showed extreme pain, he was moaning and groaning, he was obviously hurting. His meds were typical, some PRNs, some other stuff, and Oxy's 20mg q8h. Nobody could figure out why he was in so much pain with all the Oxy's and prn Vicoden. He was vomiting about 30cc of blood every 10 minutes or so. Gee, I wonder why those pain meds weren't working??? Grrrrrrrrrr

I had to beg, plead, and fight for an order for Duragesic. You know how long it takes for those to kick in, it isn't like IV Morphine where they are better after a few minutes. He was really hurting.

I called and requested a Fentanyl drip, PCA, anything. They said no, his pain was managed with Oxy's. I explained, it did no good.

Do you know I actually thought about crushing some Oxy's and blowing them up his nose? I just wasn't sure how to get it up there to be really honest.

Why should a terminally ill CA pt on hospice be in pain due to stupidity?

I put his 100mcg Duragesic patch on his arm and heated it up with a blow dryer. He looked at me like I was nuts but you know what? It worked.

Then he died a couple of hours later. My poor Dad, I will never forget the pain he was in. That image is burned into my brain for the rest of my days. I can't imagine the pain he experienced.

I think I had this weird belief that I don't know where it came from. If we really work hard and take care of our patients, the world pays us back by taking care of us and our own when it is our time. I don't think I realized I had that line of thinking until my Dad died. Then I realized that this line of thinking? Total crap.

People die in pain and there is no reason for that. It's due to stupidity and lazy staff and nothing more.

[kadokin, ASN, RN]

I think I'm guilty of this. I work with babies, and you can't always tell what's bothering them. But it bugs me when I come on to care for a baby that had a circumcision or hernia repair (pretty minor NICU stuff) the day before, and the nurse before me says, "Yeah, he really didn't seem to need Tylenol or anything, so I didn't give it." Heck, the poor kid had a scalpel to him yesterday!!! Like you get some badge of honor for not needing to give the pain meds? I say load 'em up and make them feel better!!! So I always give PRNs, pretty much as often as ordered, just because I know that if that poor baby goes a whole day with NOTHING, maybe then he'll get so uncomfortable that one little dose of baby Tylenol won't touch his pain later on.

Same thing with sedation meds. I'm a big fan of them. It's not that I want my patient to sleep all night and not "bother" me - not that at all. It's just that I want them to have some uninterrupted, restful sleep, because that's when all the best growing and healing occurs.

Exactly. Baby to senior citizen, a hospital can be a difficult place to get adequate rest. Head off the misery before it starts.!

[babynurselsa, RN]

OOOOHHHHH Bipley, I am so sorry for your father and the suffering he endured. There are so many other options for delivering meds. It is very common to use things like nebulized morphine, topical gels, rectal, and sublingual. I have used all of the above until I found what worked for the individual.

Whether it was laziness, stupidity or cost containment on behalf of the hospice to not want to boot the cost of compounding is hard to say. Your poor father sounds as though he was done a great disservice.

THis makes me very sad and angry.

[Bipley]

OOOOHHHHH Bipley, I am so sorry for your father and the suffering he endured. There are so many other options for delivering meds. It is very common to use things like nebulized morphine, topical gels, rectal, and sublingual. I have used all of the above until I found what worked for the individual.

Whether it was laziness, stupidity or cost containment on behalf of the hospice to not want to boot the cost of compounding is hard to say. Your poor father sounds as though he was done a great disservice.

THis makes me very sad and angry.

Thank you for saying that. Although I was 43 when he died, I was still a daddy's girl in every way. He was very cool and I miss him a great deal. But you know what? I could deal with all this much easier had he not had to suffer the way he did.

All in all it was probably not the worst lesson in the world for me. For him, yes, but not for me. I'm hyper aware of pain issues now. While I don't think I have really changed how I do things today vs. before my Dad died, I am more aware today.

I guess it is true, the hardest lessons teach us the most.