IV pain meds in LTC

[CoffeeRTC, BSN, RN]

Of course we do the IV push prns and years a go we've had morphine drips, but I was wondering if you've had any PCA pumps in LTC setting.

I was told, that "they" (administration) don't want/ we can't have any drips or PCA pumps in our building?? I know we have policies for them (just checked the other day) and like I said, a few yrs back we took a pt with an epidural infusion she had while at home. I also know that LPNs are permitted to monitor them in PA,so it isn't a nurse practice act thing.

So..any input LTC nurses?

[fultzymom]

I am in Southern Ohio. We have had both drips and PCAs. They were both in rare occasions. One was a man who was dying on Cancer. Nothing we did controlled his pain. We sent him to the hospital and he came back with a Morphine drip. Then we have had a couple of patients who have had the PCAs who we educated them on how to use, then they got to go home. But we have only had a couple of these in the facility.

[CapeCodMermaid, RN]

Ive worked in several LTCs we never did IV pain medicine. We don't do IV push anything..certainly not morphine. We've had a few PCA's but these were limited to subq and not IV. I don't know if it's the nurse practice act or because this is Massachusetts.

[Xbox Live Addict]

I have never seen IV pain medications in LTC. The only things I've seen given IV in LTC were antibiotics and IV fluid replacements (NS, D5W, K+, etc). Certainly I've never seen anything given IV push, since only RNs can do that here and the vast majority of LTC nurses are LPNs, and I've never seen a PCA pump in a NH.

[CoffeeRTC, BSN, RN]

Wow...When the occasion arises, we do IV push pain meds, but we always have an RN in the building (well, almost always...by law we don't need an RN on 11-7s, but we almost always do)

Years ago we had a med error with a pt on a MSO4 drip. (no bad outcome, but potential for one) so I think that is one of the problems. But that was yrs ago and different management and different nurses.

Our facility keeps admitting these pts that need or potentially need different treatments than the norm and it seems to me that we will do everything else than what is needed.

I'm not even sure if insurance issues might be in play here, but for heaven's sake....the pt should come first, huh?

[marjoriemac, LPN]

Over the pond here, we don't do iv anything in care homes, sub cutaneous is okay in some homes but depends on GP cover and staff training.

[nightmare, RN]

We often have syringe drivers in palliative care,these are all sub-cut.Policy is we never have IV's only sub-cut and that includes replacement fluids.

[Xbox Live Addict]

Over the pond here, we don't do iv anything in care homes, sub cutaneous is okay in some homes but depends on GP cover and staff training.

Wow... sub-Q "okay in some homes"? A big part of every day in every NH I ever worked in was fingersticks and insulin injections; there are so many diabetic elders these days. Also, many residents were on monthly B12 shots(SQ or IM), and there was the occasional MS patient who received Avonex injections weekly. And the annual flu shot.

IV therapy is generally only done if the facility will receive Medicare (aka SNF) money for it. Mostly, it's antibiotics via heplock, although I have seen a few here and there on fluid replacement. I haven't seen anything else given IV in LTC though, and never anything IV push.

[Xbox Live Addict]

Wow...When the occasion arises, we do IV push pain meds, but we always have an RN in the building (well, almost always...by law we don't need an RN on 11-7s, but we almost always do)

Years ago we had a med error with a pt on a MSO4 drip. (no bad outcome, but potential for one) so I think that is one of the problems. But that was yrs ago and different management and different nurses.

Our facility keeps admitting these pts that need or potentially need different treatments than the norm and it seems to me that we will do everything else than what is needed.

I'm not even sure if insurance issues might be in play here, but for heaven's sake....the pt should come first, huh?

By law, we only have to have an RN in the building eight hours a day... if the facility receives state money, as most residents are Medicaid.

I do see your point in LTC facilities taking patients whose care needs they cannot possibly meet safely. It's all in the name of getting more lucrative Medicare money for SNF services.