over medicating?

  1. Hi all...we have a Doc who is relatively new to hospice and he is also on our board of directors (VNA)...he feels that we are using too much Roxanol on his pts...he feels that they are too "out of it too soon" and that we should use something other than morphine and lorazepam...it gave me pause to rethink things since it does become so routine to order these meds...any info that I could pass on to him would be helpful...ps he is a good guy maybe he just needs more info and it would help if our medical director would show up for our IDT's (talk about frustrating :angryfire) Thanks Janie
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  2. 4 Comments

  3. by   gizelda196
    It is very frustrating,especially when management is oblivious.End of life care ,be it palliative or comfort measures ,is a fine line.Roxanol and Ativan are the standard.You can try printing out some info on the standards and the goals of both
  4. by   txspadequeenRN
    gosh i hope you can change his mind. there is a doc where i work who orders ativan intensol and roxanol giving us perameters and says " use it, it hurts to die" he says all the body organs shuting down causes pain and the patient being unable to show the s/s ,we dont monitor v/s during the dying phase how would we know about the level of pain!!!! no one needs or deserves to die in pain !!!!!!! :angryfire





    Quote from saribeth
    hi all...we have a doc who is relatively new to hospice and he is also on our board of directors (vna)...he feels that we are using too much roxanol on his pts...he feels that they are too "out of it too soon" and that we should use something other than morphine and lorazepam...it gave me pause to rethink things since it does become so routine to order these meds...any info that i could pass on to him would be helpful...ps he is a good guy maybe he just needs more info and it would help if our medical director would show up for our idt's (talk about frustrating :angryfire) thanks janie
  5. by   Angelica
    Ativan and roxanol are my two favorite drugs. Don't know what I'd do without them.
  6. by   Lily of the Valley
    We tend to run to the Dynamic Duo very quickly, and then stay there forever
    I find that starting with simple analgesics, especially for the narcotic naive is often more comforting for patient and family
    Much depends on how early a patient comes on service and diagnosis
    Dementia is not always painful
    Not to be dismissed (and addressed with Ativan) is the effect of anxiety and depression on pain perception, risperdal, trazodone, haldol (brilliant for nausea as well as decreasing the hallucinations sometimes triggered by morphine)
    We often start with Trilisate, or even Tylenol for pain less than 4 or 5
    We all know the magic of the Dynamic Duo on ease of breathing, but sometimes no matter how high the dose of MSO4, the patient still has pain or is sleepy
    We use methadone for severe pain instead
    Pain is relieved, they are awake and alert, and can lead more normal lives
    The half life of 100 hours makes coverage easier (though increases must be very slow to allow the couple of day window for full effect)
    This long half life is also fabulous when a patient is unwilling or unable to take anything by mouth at the end... pain relief is still on board

    Lily

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