Giving narcs

[HM7380]

I work as a charge nurse in a LTC facility. Every once in a blue moon, I end up on a med cart, which is great, as I can check up on what meds have/haven't been given, etc. (I've only been doing this for 1 1/2 yrs). My problem is that apparently, I'm the only person who gives out pain pills/other assorted narcs on my shift. I usually give them out to the people who are terminal, or otherwise are unable to adequately tell me how much pain they're in because of dementia, etc. I feel like I'm going to be flagged when state comes in for being the only person who's handing out handfulls of narcs to people who NEED them, but can't express it. I've asked the med nurses to give pain meds to those who (in my opinion) need them because after a year and a half of working closely with these people, I know what their pain symptoms are, but apparently, no one gives anything out, (perhaps out of laziness?). What should I do? Stop giving them myself?

This is my first nursing job, and while I've learned a lot, I still don't know *much* in the grand scheme of things. :) I'm sorry if this is a stupid question. Like I said, I'm still relatively new at this.

[bluegeegoo2, LPN]

I always give my terminal residents pain meds! I usually don't the others unless there are pain markers I can see. I would (and do) continue to give them, just be sure to chart what you were seeing that led you to believe they needed an intervention. Some of my aides have told me there is a nurse who won't give a prn for ANY REASON, even if they ask for it. She thinks she's just "doping them up". (A fresh hip? PLEASE dope me up!) I usually don't give them the strongest med they have available unless it's very obvious they are in a lot of pain. If your facility is anything like mine, it's a pain to give prn's. We have to chart it all over the place, so maybe laziness has something to do with it? Since you are charge, I would ask them point blank why they aren't addressing the pain management needs of their residents. Maybe they aren't seeing what you're seeing, and you may be misreading the res. It happens. I had a lady who looked to be in a fair amount of pain while sleeping, judging by the "scrunched up" look on her face, but when asked, she denied pain. In fact, she would seem surprised that I even asked. Don't forget to chart, chart, chart! That way, at least you cover you're hindquarters when state comes in.

[softstorms]

terminal pts. and short term acute pain pts (fresh hip fx.) are two very different things. Most facilities use commen pain management scales, both facial, behavial,and verbal to monitor pain. Encourage your facility to use these and you should have little problem with encouraging your nurses to give medication when needed and documenting it.

[sasha2lady]

As long as you have plenty of factual documentation on why you gave what you gave you should be fine. that is one thing that state looks at in depth in my state...we were just informed that here in nc...darvocets are going to be done away with in elderly pts....they say that its not as effective and therefore it will changed over to some other pill...i know its white but i havent had a chance to actually use one for one of my pts yet. As for the others, it could be laziness and a lack of desire to chart that stuff everywhere or it could be b/c they are in a hurry to get their meds done or what not. You can ask them why they dont give them but it wont necessarily mean that any of them will start doing it.

[systoly]

Please do not stop giving pain meds. You said," I know what their pain symptoms are". If you chart your observations before and after, you won't have anything to worry about. In fact, I believe the folks who under treat pain should be concerned. Just make sure you consider non narcotic alternatives or adjuncts.