blame the morphine | allnurses

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???
  2. Visit  pnhopeful profile page

    About pnhopeful

    From 'US'; Joined May '06; Posts: 61; Likes: 8.

    20 Comments so far...

  3. Visit  Daisy_08 profile page
    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.
  4. Visit  tewdles profile page
    3
    It sounds like you peers would benefit from some hospice education...
    blueheaven, gonzo1, and nrsang97 like this.
  5. Visit  loriangel14 profile page
    3
    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.
  6. Visit  pnhopeful profile page
    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.
  7. Visit  loriangel14 profile page
    1
    If you Google " palliative care morphine myths" you will gets lots of hits.
    pnhopeful likes this.
  8. Visit  tewdles profile page
    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.
  9. Visit  echoRNC711 profile page
    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.
  10. Visit  lantanaRN profile page
    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.
  11. Visit  pnhopeful profile page
    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.
  12. Visit  pnhopeful profile page
    1
    Quote from lantanaRN
    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
    I wish you could come and educate at this hospice! They are RNs and think they are hospice trained. Where I live one does not have to be CHPN to work in hospice. I would love to attend a symposium or class regarding this issue.
    tewdles likes this.
  13. Visit  rngolfer53 profile page
    5
    Generally, there is no requirement to be hospice certified to work in hospice. It depends on the particular organization. Personally, I would leave, as quickly as I could given the realities of employment, an agency that didn't have at least the medical director and most case managers certified.

    A resource that's handy, free, and readily available with a smart phone, I-Pad, etc is Hospice Fast Facts.
    End of Life/ Palliative Care Fast Facts

    It's no substitute for a good hospice education program, but it's a quick reference for guidance in symptom control, communication, teaching, etc.
    Last edit by NRSKarenRN on Nov 4, '12 : Reason: edited link
    Amy'sGrandbaby, tewdles, leslie :-D, and 2 others like this.
  14. Visit  gonzo1 profile page
    0
    As hard as it is I believe you must educate and tell these coworkers and families involved that this is just not true. We all have a tendency to downplay that the pt is dying and there is no hope for recovery. I see this all the time in my ICU. Families just won't let go, and we are afraid to talk about the truth with them for fear they will think we are trying to kill their loved one.


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