blame the morphine

  1. 1
    I have been running into this a lot lately with my hospice nurse coworkers. Patients' declines and decrease in level of consciousness are being chalked up as "over-medication". This misconception is happening with actively dying patients as well as those with simply an increase in or uncontrolled pain. The patient is typically medicated PRN with morphine for pain or SOB. These are patients who are on starting doses of 5mg range. The knee jerk reaction from this particular small hospice company is that the patients are over sedated from pain meds. I expect this from lay people, but is difficult to deal with from professionals. No one in the company is hospice certified, including the medical director. I have seen a few deaths with uncontrolled symptoms that make me cringe to think about. How would you deal with people who attribute normal declines involving increase in sleep/increase confusion to morphine???
    echoRNC711 likes this.
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  3. 20 Comments so far...

  4. 2
    That's sad to hear from your co-workers. It demonstrates a lack of knowledge and education. Yes, I hear it from family and try and use those moments teachable ones. But your right it is just sad when it comes from professionals.
    gonzo1 and nrsang97 like this.
  5. 3
    It sounds like you peers would benefit from some hospice education...
    blueheaven, gonzo1, and nrsang97 like this.
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    What role are the doctors playing in all this? Quite often they are woefully ignorant when it comes to pain control. You would think professionals would understand the dying process.
    blueheaven, gonzo1, and nrsang97 like this.
  7. 0
    Thanks all! What resources or classes or books would you recommend to despell these kinds of myths? Like a hospice 101 crash course! And yes, the med director does not take charge of the hospice. In other words he lets the uninformed nurses call the shots.
  8. 1
    If you Google " palliative care morphine myths" you will gets lots of hits.
    pnhopeful likes this.
  9. 3
    Use NHPCO and HPNA resources...
    Contact your state or regional hospice association...

    If your hospice is not providing adequately for the symptom management needs of your patients then you are not meeting your CoPs. How can you say that your patients have their pain adequately controlled in 24-48 hours post SOC when the agency is practicing like this?? These are mandatory reporting data.
    blueheaven, NRSKarenRN, and loriangel14 like this.
  10. 5
    Sometimes people need to hear things clearly. As previous poster suggested your co workers could gain merit from more education. Meantime I personally would be very direct if questioned by simply stating that their perceptions "Are simply not accurate ". Stick with the facts.Pts need advocates like you. Nice job!
    blueheaven, gonzo1, pnhopeful, and 2 others like this.
  11. 3
    I'm having trouble understanding how non hospice trained personnel are even providing hospice care As a certified hospice palliative nurse I educate frequently on the myths of morphine and the actual signs of active dying process. Uneducated patients and families and other medical professionals buy into the myth and it is essential that they be educated over and over
    blueheaven, gonzo1, and nrsang97 like this.
  12. 3
    Quote from tewdles
    Use NHPCO and HPNA resources...
    Contact your state or regional hospice association...

    If your hospice is not providing adequately for the symptom management needs of your patients then you are not meeting your CoPs. How can you say that your patients have their pain adequately controlled in 24-48 hours post SOC when the agency is practicing like this?? These are mandatory reporting data.
    Lets just say their pain assessments are different than mine. Them missing non-verbal s/s of pain among other issues! I think they believe breathing 50 breaths a minute is just fine and dandy. I am considering a change, but before I do I am looking for some easy and quick educational materials for staff/family.
    blueheaven, echoRNC711, and nrsang97 like this.


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