Giving pain meds.

I once had a 88 y/o lady who was admitted to the hospital (forgot the exact dx) but the daughter decided that Mama needed to be "detoxed" from pain meds that she had been taking for years and years. And the whimpy doc went along with it....it was pitiful.
The way I look at it, if someone makes it to the late 80's and 90's....give 'em what they want! They deserve it.

For those of you who DC prn pain meds that aren't used very often, how long does it take for the doc to call back and reorder them if the patient c/o pain? How long does the patient need to c/o pain before someone calls?

I dread the day I have to go into a nursing home and have to move Heaven and Earth to get a couple of pain pills.

I agree that everyone should have pain relief. I am lucky enough to work in a facility that is very good about this. We have quite a few residents that are on Roxinal as well as vicodin and ultram. I always do a pain assessment on my residents. Even those residents that are relatively "with it" may forget that they have medication available to them if they are in pain.

If I believe that a patient should be getting pain meds and is not, even though they are ordered, I document what they are saying, and doing, and it is part of my report to the next shift. And, of course I'm going to medicate them (or even wake up a doc if I need to and nothing has been ordered). If it is happening consistently, I question that nurse about the patient's behavior on her shift. Some patients do not require pain meds on all shifts due to a variety of reasons that are legitimate. I would however be concerned if I am seeing someone in pain everytime I work with them on my shift, and note that nothing is given night after night. In LTC, I might even get get the MDS nurse involved if I thought it would help. Pain needs to be addressed. Not doing so is neglect.

I have to tell you guys, since I posted my opinion on admin of analgesics I have had a complete 180 degree turnaround in my attitude! When I flush this one Rsd feeding tube Q night she asks for "something for pain". I've been giving her PRN lortab. Well, one of my aides told me 2 d ago that my RN supervisor told her she thought I was taking the lortab for myself cuz I'm the only one giving it to her! I can't believe she told my aide this (I'm the aides supe at night)! Why she didn't confront me directly I've no clue. I want to confront the RN about this but the aide is begging me not to cause trouble. This is my last wk there (I'm moving 3000 mls away) and doesn't want trouble w/ this lady after I leave. I will no longer hand out PRN's unless I have to. I hate to become hard but if this is the result of being compassionate then I can't afford it. I am new nurse this has really rattled me. What do I do? Let it go?

You follow the good training you were giving in nursing school and you do a pain assessment and you chart it. Where do you hurt? What is the pain like? You rate it on a 10 point scale. You ask how frequently the resident experiences the pain. You then chart the effectiveness of the pain medication. If she is slumbering peacefully 30 minutes later then you chart "sleeping with no visible signs of pain, no restlessness, no grimacing, no moaning or calling out."

Stand tall and follow good nursing practice. Do not let other's poor practice standards reduce your own. What you cannot afford to do is compromise your integrity as a nurse.

Thx for the support! I REALLY hate to become hard, hate to change my basic personality, do things against the grain. Maybe I can find a compromise. This particular pt is a stroke pt w/ limited verbal ability (I think). She usu goes to sleep after I give her the lortab. I only see her at night. What I've been doing is having an aide stand w/ me at the med cart and go into Q pt's room that I must give any kind of narc to. I'm trying to protect myself here. Come to find out the last 2 nurses on this unit actually got caught w/ pt drugs on them so this RN is overly suspicious. I'll do what I need to do to protect my license, my livelihood, after all I have children to feed. I need my job. I'm only there for 1 one more wk. Incidently I've only been w/ this company for 5 wks. My husband lost his job my 1s there so we are moving back up north. I'm scared to be a good nurse at this facility when it comes to admin pain meds. I can't afford this trouble or doubt. I don't need this hassle. I gave out PRN's at my 1st job up north w/ no problems. Maybe it will be different at my next job and I can be the kind of nurse I want to be. Good idea to document Q thing reain meds. I will start doing that. I will be the only nurse there who does that also!

"Stand tall and follow good nursing practice. Do not let other's poor practice standards reduce your own. What you cannot afford to do is compromise your integrity as a nurse."
Couldn't have said it better myself. If YOU know what you are doing is the right thing for your patient and you are following protocol, don't let someone who is misinformed or misdirected or miswhatever change the way you do things...especially when it comes to pain control. I think most residents at a facility are way undermedicated when it comes to pain. The docs think nothing of prescribing 3 nasal sprays for a stuffy nose but tell you to give someone with crippling osteoarthritis one tylenol every 8 hours....barbaric.

I agree. I KNOW pt's at LTC's are undermedicated. I KNOW I'm not guilty of anything but it doesn't make me feel any better. I am very uncomfortable working there now. I wish she (my RN supe) would confront me directly and just ask! Jeez! Why tell God knows how many people yet not give me a chance to defend myself! Poor supe skills. Has anyone else ever had this problem?

Tammy,
I really hope that one person's flippant remarks are not going to cause you to abandon what is best for your patients. It is our job as nurses to be advocates for our patients. I do understand your anxiety, though, and I hope your new job is a more supportive one.

~mel'