Overuse of opiates?? Opinions?

leslie :-D · Aug 10, 2004

Judge not lest thou shalt be judged
Assess. Intervene, Evaluate effectiveness of Intervention
Sometimes you need more medicine
Sometimes you need a swift boot out the door

isn't that what i said?

dang, i hate being wordy.

teeituptom, BSN, RN · Aug 10, 2004

isn't that what i said?
dang, i hate being wordy.

Thats pretty much what you said

I just use nfewer words is all

Keep It Short. Sweet Simple

leslie :-D · Aug 10, 2004

Thats pretty much what you said
I just use nfewer words is all
Keep It Short. Sweet Simple

i think i'll shadow you.

**canoehead, BSN, RN** · Aug 10, 2004

Tom is the guru of the stress free ER experiance.

hipab4hands · Aug 10, 2004

and does anyone else feel that the doctors are part of the problem? i'm growing more and more intolerant of this whole horse and pony show. after a night like last night it really makes me think about my career choice. :uhoh3: :uhoh3:

absolutely, the docs write the scripts and won't refer patients to chronic pain managment clinics.

the docs in the hmo, where i work, hand out vicodin like it was m and m's. they continue to provide the med to patients long past a therapeutic use to keep the patients from complaining. once the patients become a pain in the a** due to drug seeking behavior,then they cut off the meds.

in return, we nurses are the one that have to deal with their patients, because now the docs won't return phone call from these patients and won't refill their scripts.

nursbee04 · Aug 11, 2004

LOL...how old are you? Was that intentional? Please don't tell me you're too young to know the "Fab Four." I can't handle another reminder of my age today! :chuckle
I was taught all of those misconeptions back in the dark ages when I was a student.
z: Thanks!

21. Nope, wasn't intentional, just a mistake.

deepbreathe · Aug 11, 2004

Let me be the first to say I believe in pain management. The key word is management. I've given conscious sedation to countless people, 8 hours a day, 5 days a week for well over10 years. I'm known for the fact that people are pain free during my procedures. I think what I said was, we've allowed the mentality of entitlement to go beyond what it was meant to do. Living a life as a legitimate junkie is ruining more than the patients life, it ruins those around them too. I'm talking about abusers, life time of seekers. Pain is a bodily function. Wake up, it is a signal that something is not quite right in the body. My dad died of complications of septicemia...he had rheumatoid arthritis for 20 years, was sure he wanted to pain free, took depomedrol IM for years (Through Dr.R. Kaye, Standford University Hospital), and it destroyed his inflammatory responses, while it kept him pain free. So a massive infection took his life, without even a whisper to let us know how severe it was....pain management is the key. I am not in favor of pain, but it is a reality. Keeping people in a pain free state can mean so dependent, or so out of it, they really are not themselves, and they are not without dangers of pain medications. Management to a level of reasonable, with the hope of either eliminating the source of the pain (thus the real answer), or providing a way to live safely, exploring the alternatives. That's what pain evals do... they look at the whole person, body, mind and soul.

leslie :-D · Aug 11, 2004

well deepbreathe, now that your sentiments are more clarified, i agree with you.

if the risks of meds are going to outweigh the benefits then yes, people should get used to living with a pain rating of 3 or less...that's reasonable.

i am also sorry about your father.....as with taking any steroids, these risks are well known of masking s/s of infection.

wishing you peace.

leslie

IR5676 · Aug 19, 2004

oh, Lord, the concept of pain management is becoming a big issue...I know when I am having pain, from spastic bowel or dental issues, the run of the mill Lortab or Vicodan doesn't work. That's just me.....a lot of people are the same way....what works for most doesn't work for them. For chronic pain issues, they don't become addicted once the magic bullet has been found. I can receive 100mg of Demeral and 75mg phenergan and walk and talk without difficulty, but it numbs the pain....but I don't want it afterward. Some of these people have legitimate pain and should be treated aggressively, and the nurses should talk to them, because the pain may be referred pain and not from what we think.

jeanrnurse · Aug 19, 2004

Reply to Rapheal: As a Staff Development Educator, I am discouraged that nurses and MDs continue to be misinformed about Demerol, which is VERY over- and misused, as in the example you gave.

Many hospitals have eliminated it from their Formulary or have severely limited it's use, because toxic byproducts build up in the body. And there are many other meds more appropriate. Demerol 50 mg is not more effective than 2 Tylenol, and research has shown Phenergan to be basically ineffective an a potentiator in a 25 mg dose.

And the action of Demerol only lasts 2-3 hrs., so ordering it q4 does the pt. a disservice. Pts. who complain that this regimen is ineffective are CORRECT. They are not drug seekers. Instead of letting the MD get away with ordering this outmoded regimen, nurses should take the opportunity to educate them that other narcotics, with or without NSAIDS, given ATC rather than prn, are much more effective.

You can consult McCaffery & Pasero's book on Pain Mgmt. for specifics.

rasberrikiss · Aug 20, 2004

I have an elderly resident on 100mcg duragesic changed every 2 days instead of 3, oxycontin 80mg every eight hours, and two vicodin every six for breakthrough pain, and she takes this around the clock, she also takes ambien every night. Her dx is left shoulder replacement! She s a frail lady and doe not even seem phased by the medication. She actually says she needs more!! I think that the doctor has allowed this woman to become addicted to these drugs because they keep increasing them and of course she will build up a tolerance!

apaisRN, RN, CRNA · Aug 23, 2004

I have a different perspective, I think. I believe everyone should get adequate or even more than adequate pain management, and if it means we enable some junkies, oh well. My job is to care for people after surgery, not treat addictions. That can wait until they leave the hospital. I'm always generous with pain meds and an advocate to the MD re: pain management. I guess I'd rather feed an addict, or give someone a touch more than was needed (assuming it doesn't harm them) than have any patient of mine have treatable pain. I had a professor once who said "There is enough morphine in the world that no one should have to be in pain." There are exceptions to that rule, but really, what use is modern medicine if people still suffer needlessly?

I have not had much of an issue with frequent flyers and vague complaints when I worked med-surg. I don't know why - my patients were almost always post-op or had gallstones or some other extremely legitimate source of pain. The drug abusers had a legitimate source of pain too, it's just that a.) their pain was harder to treat and b.) they played the system for drugs.

I remember a guy, a very successful ex-addict on methadone, who had an enormous debridement for necrotizing fascitis. Huge pieces of his thighs removed, skin grafts and harvest sites all over. The guy had a PCA, scheduled MSContin, methadone, and a 20-mg morphine bolus for dressing changes. Yowee. He still screamed during those dressing changes, too, and I don't think he was acting.

I know that because I am in the ICU, I have a freer rein than some of you. On my vented patients, it doen't matter if I give enough narc to suppress resp drive (unless they are weaning). Even if the patient isn't vented, they are monitored, so I feel confident that I won't walk in and find an obtunded patent breathing at 4/min. When I pick up a shift on my old surgical floor, I'm more careful, because I may only see my patients once every couple of hours when it's busy. They could be dead by then.

In the ICU, someone being an addict is the absolute least of their troubles and anyone sick enough enough to be there probably needs something to take the edge off. We do terrible things to ICU patients - intubate them, trach them, place PEGs and G-Js, allow interns to stab them repeatedly for central lines and art lines. Nurses always believe they are undersedated, and some are generous with their interpretations of the doc's sedation orders.