Giving less pain medication b/c of sedation

  1. Just wondering what nurses "legally" can do about this. If your patient's family member continues to ask you for pain medication for the patient but you are concerned about the dose, r/t sedation, age or it was recently given in the ER before the patient was just admitted. I was always told that we can give less of a pain medication, wait and then possibly give it later or not at all. If the order says 5-10 mg but you only give 2 or 4mg, what are the consequences? Is this an unsafe practice?
    I know it is easy to say "call the doctor and get another order", but in reality how many of us have been doing this? I just wanted to know. I routinely work night shift and to call the doctor is not a pleasant experience, especially if you are asking him/her to change their own order b/c you don't agree with it!!

    Thanks,
    MB
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  2. 5 Comments

  3. by   wtbcrna
    Quote from bobbysox4
    Just wondering what nurses "legally" can do about this. If your patient's family member continues to ask you for pain medication for the patient but you are concerned about the dose, r/t sedation, age or it was recently given in the ER before the patient was just admitted. I was always told that we can give less of a pain medication, wait and then possibly give it later or not at all. If the order says 5-10 mg but you only give 2 or 4mg, what are the consequences? Is this an unsafe practice?
    I know it is easy to say "call the doctor and get another order", but in reality how many of us have been doing this? I just wanted to know. I routinely work night shift and to call the doctor is not a pleasant experience, especially if you are asking him/her to change their own order b/c you don't agree with it!!

    Thanks,
    MB
    Each case is so individual it is hard to make a blanket statement. I am learning in anesthesia school that it is a lot harder to OD patients then I used to think. 5-10mg Morphine will rarely do it, but I see nothing wrong with giving half the dose then waiting a few minutes and then giving the other half. I personally have pushed over 60mg of Morphine on one patient in PACU and still had him wide awake sitting up complaining of pain. On the other side I gave an elderly lady 2mg of morphine and she developed severe respiratory depression and had to get Narcan.

    I see nothing unsafe about giving part of the medication waiting for the peak effect (which shouldn't be long with most IV meds) and then giving the other half. This is just using proper nursing judgement. Where you might get in trouble is if you don't end up giving the other half of the medication, and then you don't properly document/notify the provider.
  4. by   CRNA2007
    You should not be dosing your patient's pain medication at the request of family members. Yuo need to assess your patient an implement from there. Sometimes patient's and family members have a very unrealistic expectations of complete absolute 100% pain control and that is not always possible.



    Quote from bobbysox4
    Just wondering what nurses "legally" can do about this. If your patient's family member continues to ask you for pain medication for the patient but you are concerned about the dose, r/t sedation, age or it was recently given in the ER before the patient was just admitted. I was always told that we can give less of a pain medication, wait and then possibly give it later or not at all. If the order says 5-10 mg but you only give 2 or 4mg, what are the consequences? Is this an unsafe practice?
    I know it is easy to say "call the doctor and get another order", but in reality how many of us have been doing this? I just wanted to know. I routinely work night shift and to call the doctor is not a pleasant experience, especially if you are asking him/her to change their own order b/c you don't agree with it!!

    Thanks,
    MB
  5. by   cmo421
    Giving more or less then what is ordered is not within our practice. If you are concerned about a dose, you need to consult a Doc. Do not take matters into ur own hands.
    It is not within your scope of practice to decide some dose is too little, or too much. If you have concerns, do an assessment,vs and notify a doc. Always pass the puck up when a med decision is an issue!
  6. by   wtbcrna
    Quote from cmo421
    Giving more or less then what is ordered is not within our practice. If you are concerned about a dose, you need to consult a Doc. Do not take matters into ur own hands.
    It is not within your scope of practice to decide some dose is too little, or too much. If you have concerns, do an assessment,vs and notify a doc. Always pass the puck up when a med decision is an issue!
    I would have to disagree giving half a dose then waiting to see that there is no adverse response before giving the second half of the dose is well within nursing scope of practice/nursing judgement.
    I do agree that if your ever uncomfortable with an order you should call the provider after you have reviewed the order.

    You can always give more, but you can't take back what is already been given.
  7. by   cmo421
    [quote=wtbcrna;2513481]I would have to disagree giving half a dose then waiting to see that there is no adverse response before giving the second half of the dose is well within nursing scope of practice/nursing judgement.
    I do agree that if your ever uncomfortable with an order you should call the provider after you have reviewed the order.

    You can always give more, but you can't take back what is already been given.[/quote

    I have done the same. I was just saying that legally,it is not within our scope of practice to change the dose of a med without any order.

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