I am Charge RN on a 26 bed Med/Surg unit. I was accused of withholding a patient's pain medication. Here's the situation. I would appreciate hearing how other nurses interpret this situation.
The patient had a lip abcess I&D'd. He had two PRN pain medication orders. Demerol q6 prn, and Lortab q4 prn. He had received Lortab at 2200. At 2400, he was going to leave the floor to smoke, but his EJ access had come out, so it took almost an hour to resite him so he could get his antibiotics. After this was done, he asked for his Demerol. I asked him if he was going to go smoke, and he said that he was through for the night, so I gave him the Demerol. About 30 minutes later, he was going to smoke. I advised him of the risks, but he went anyway! When he returned, I told him that it would be 0700 before he could get anything else. About 0300, he was asking for the Lortab.
I was taught that if neither order was written for breakthrough pain, which neither was, you had to wait the time frequency of the last medication received, before giving anything else, to keep from overmedicating someone.
Thatmorning, he complained that I had withheld his pain medication. I was written up for this. My nurse director said that I should have given the medications 'as ordered'. I attempted to explain to her how meds are given, if neither are for breakthrough pain. All she said was, 'what is the policy?' She could not even tell me. I have not had the chance to see if my facility has a clear policy on this.
Please let me hear some perspective on this. I feel I carried out the orders correctly. It would be great if someone could direct me to a definitive policy on this.
