Giving pain meds.

1st edition · Jul 18, 2006, 07:08 AM

At this particular job I'll be very cautious and rein my natural instincts to be kind in re: pain med admin, I'll play it by ear at the next job. Thank God I only have one wk left there! If I was going to stay there I would march her (my RN supe) to the DON and get this settled. Maybe she didn't say it and the CNA who told me about did? This has certainly rattled me and caused me to doubt what a good nurse does. I know we are advocates but at what price???

BackInTheGame · Jul 18, 2006, 07:39 AM

I personally would wonder why the aide is so adamant about you not asking the RN about it. I agree with so much that has been said here and one can never overemphasize the need to DOCUMENT DOCUMENT DOCUMENT!!

Maybe you could say something to the RN quietly. You're leaving anyway so maybe say hey is there any advice you could give about my performance or in areas where I could improve... I dunno.. something along those lines.

banditrn · Jul 18, 2006, 12:18 PM

Thank you all for your replies. I'm glad I'm not the only one that feels as I do.

We count everything from Xanax to morphine - I agree that if a med hasn't been taken in a couple of months, that it should be dc'd, but if they are taking it regularly, then they should be allowed to keep it. Altho I do feel that they should be assessed more often, and it should be charted WHY they need it.

The LPN that dc's all these drugs has worked in this same LTC for many years, and has never worked in a hospital. I feel like it's kind of a power thing with her. She will only give Tylenol - then when I get there at nite, they ring for something else, because the tylenol hasn't helped.

OTOH - the last nite that I worked, 20cc of one ladies prescription cough syrup 'disappeared'! The lady doesn't take it often, and when she does, the dose is only 2.5cc. This concerned me, and I pointed it out to the DON who doesn't seem concerned.

BackInTheGame · Jul 18, 2006, 01:00 PM

We d/c unused pain meds too and our DON is the only person who has the authority to destroy d/c'd meds with the facility supervisor as witness. What gets me fired up is a doc who d/c's pain meds that ARE being used on a regular basis. Had a pt once who's pain assessment was always in the 8-10 range with Lortab taking it down to maybe a 3 and Ultram only taking it to a 5-6. The doc decided that the pt couldn't possibly be in that much pain and d/c'd the Lortab and Ultram and left us with nothing but Tylenol q6h. This is also the same doc who told me that the liver problems I have (non-alcohol steratohepatitis) can't possibly cause pain either. Hmmmmm guess who is no longer my doc.. lol. The pt has asked repeatedly to see the doc face to face but all the doc does is come in, review the chart... which btw has qshift pain assessments and documentation of pain meds and effectiveness... and then quick as a flash is gone from the unit. The doc even admitted once to our DON that she didn't like her job... ok that's fine, but why take it out on patients who are dependent on her for care?? I just don't get it.

marymack57 · Jul 18, 2006, 05:27 PM

An oncologist told me that anyone who has pain CAN'T be addicted to medication. What indicates "addiction", in his words, was the person without pain taking a narcotic for the euphoria it generates.
I've tried to keep this in mind over the years I've worked in LTC. It has proven beneficial to some, I know.

banditrn · Jul 19, 2006, 02:22 PM

Back in the Game - we had a few of those at the hospital where I worked - we used to fantasize about them coming in for surgery, then only giving them Tylenol q8!

In the post-anesthesia unit where I last worked, most of the surgeons were great about pain meds, but we had one old doc who would always order 1 Darvocet q4!! I would give it, then call him every time to tell him it WASN'T WORKING! Then he'd order morphine.

I've never had a problem calling any doc, anytime, when their patient needed something important!! If they weren't happy about it, too bad! It's our job to be advocates - the few who didn't like it were a little more appropriate the next time, because they knew they'd get a call if they weren't.

NoWaNrN · Jul 19, 2006, 03:03 PM

We were always taugh pain is what the pts says it is! I firmly go by that. I do see an exceeded amt of narcotics ordered, if they don't take them then try to get them d/c. Some like to take vicoden to sleep where I work. We have a couple of retired RN's at our LTC facility and boy do they like there vicoden! But your right there not gonna be on the street corner trying to buy drugs so if they get addicted, at least they are comfortable in the dying process. I wouldn't want to be in pain. They shouldn't have to be either.