Waking resident to give pain injection?

  1. Has anyone ever heard of waking a resident from a restful sleep in order to administer an IM injection for pain? A particularly difficult family has requested that we do this for their father and our DON has gone along with it to keep peace. The resident is able to request pain meds when he needs them and we watch him for any signs of discomfort. He also get Vicodin 10/650 q 4h while awake. The injection he is to receive is Nubain 10mg. with Phenergan 25mg. I strongly believe in adequate pain control but I have a problem with waking someone who is sleeping well to give them an IM injection. I discussed my feelings about this with the DON and she called the physician and got him to okay this for at least 48 hours but I still wonder about any liability that may occur. I would be interested to hear some opinions about this.
    THanks!
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  2. 14 Comments

  3. by   VivaLasViejas
    I would ask the MD to consider switching to an IV pain med, given through a saline or heparin lock, on a regular schedule to manage pain without creating unnecessary sleep interruptions or physical distress. As you are probably aware, pain meds work best when given around the clock rather than on a PRN basis, and this way you're making sure the resident is receiving them in timely fashion without disturbing his sleep, which is also important
    in pain management (you might clue the family in to this as well).
    Good luck.
  4. by   RNonsense
    What does the resident say?? Anyway, perhaps a fentanyl patch or whatnot would be a better regime for him...
  5. by   aimeee
    What is the source of this resident's pain? If this person has around the clock pain, then he should have a long acting pain med scheduled like oxycontin or a duragesic patch and also have a prn dose for breakthrough pain.
  6. by   kittyw
    Let's see.... we want to wake someone who is sleeping well to give them a painful pain shot.....

    Definately advocate for some other method. I bet a little family teaching would go a long way. If this is long term, patches or a sustained release pain med would be better. Short term - a hep lock and an IV push med would work too. I would think that anything would be better than an IM shot.
    Last edit by kittyw on Mar 18, '03
  7. by   graysonret
    I agree with RNnonsense. Perhaps a patch would work much better for the patient. At least, you don't have to wake him and you only have to change it q3 days. . Of course, it depends on what type of pain. Much better than a heplock which can carry the possibility of infection.
  8. by   NancyRN
    It really upsets me to hear about "family" telling a doctor how to practice medicine.

    I had a cancer patient crying with pain all night and all I could give her was one percocet. When I called the doctor, he said "the family" didn't want her to be groggy when they came to visit (for 15 minutes a day). Puh-leeze!!
  9. by   sassynurse78
    I agree with the patch or maybe an extended release med. I ran into this once before, I woke the person up the first couple of times, but after that i started charting the res appeared to be sleeping without s/s pain or discomfort routine pain med withheld. Once I started doing that other nurses did to, we finally got that order d/c'd and switched to a duragesic patch.
  10. by   sbic56
    It is true that sleeping patients feel pain, but why wouldn't the doc respond to the needs of the patient by ordering a patch? I'd suggest it.
  11. by   graysonret
    As anyone noticed, in the medical field, that everyone is a "doctor" but the doctor? I'm talking about friends, families of the patients.
  12. by   curlyqluli
    I firmly believe that pain medication must be taken seriously. Even though a patient is sleeping DOESN'T mean that they are not in pain. However, I also don't think that you should just poke them for their med without letting them know first. Why don't you ask the Doc to change their med to IVP? Or maybe even a PCA pump?
  13. by   nialloh
    Why not order the shot around the clock while awake. That way if he wakes up, give him a shot, if he is sleeping, let him sleep. It is hard enough for pts to get to sleep as it is, without waking them up.
  14. by   canoehead
    If you must wake the resident why not just give the po med instaed of the injection. And if you are giving a po med, why not a longer acting drug like MS Contin, so you only give the one dose and then just treat breakthrough pain during sleeping time. Seems like the doc hasn't thought through all the alternatives and presented them to the family.

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