I got a call last Friday morning that one of my LTC pts was aggitated. I was on my way to the facility already and when I got there, I heard this woman SCREAMING all the way down the hall.
She was a new admit (about 4 days) and had never taken anything for pain....not even Tylenol. I saw her Wednesday and she was very comfortable and sleeping soundly. I called and got an order for Roxanal 5mg @ 2 hrs PRN and ativan gel Q 6 hrs PRN. Pharmacy was asked to deliver STAT.
Informed the facility nurse of new orders and asked her to give as soon as delivery was made. I wrote the order in the chart and made sure the nurse understood the instructions. I have 6 other pts in the same facility, so I was going to be in the bldg for a while.
About 1 hour later I go to check on this pt again. She's sleeping soundly.
The nurse told me she gave the Roxanol and ativan gel together on the advise of her DON. GREAT! This DON really understands hospice and pain mgmt. Just before I leave the facility about 1400, I peek in on my pt again. I didn't speak to the nurse....MY BAD.
Saturday morning, our w/e nurse makes an extra visit to check on this pt since she was in a pain crisis the day before. Lo and behold! Pt is screaming out again. W/e nurse asked when last dose of pain meds were given and the nurse replied,"oh, she had some yesterday about noon." Our nurse tells her that the pt is screaming out in pain and needs morphine ASAP. The facility nurse said it was reported to her that the pt screamed all night and they finally shut her door to keep her from waking the other pts. AND YOU WILL ADMIT THIS!!!
I talked to the DON on Monday morning to discuss this issue. She is going to speak to all the nurses involved. She asked if we would be willing to do an inservice some evening or on a Saturday. YOU BET! Heck, we'll bring lunch.
This is a large facility w/ approx 250 beds. This is the first time we've had a pt on this particular hall. I've worked w/ several of the other nurses there and they are getting MUCH better about giving morphine. It's all about teaching and re-enforcing. I know some of the LTC nurses are overworked.....been there and done that so I really want to thank the OP for asking this really important question.