pt safety question, please help - pg.2 | allnurses

pt safety question, please help - page 3

Ok, the problem that I have is with Hospice and the rules. I am a LVN at a hospital and I had a pt last night that is on hospice. The Dr. and the family is waiting for the guy to die, so at the... Read More

  1. Visit  ltlshamrock profile page
    0
    I have never heard of dilaudid q1 hr for use in hospice. As long as you documented every hour comfort and stability of the pt, a nursing medication hold can be justified clinically. I would have challenged and called the legal dept. To cover yourself. Hospice is comfort for a natural death not drug overload that's why they use morphine. Fast in and fast out of the systerm. Dilaudid half-life is not the same by any means. That physician is questionable, I would have reported him.
  2. Visit  maelstrom143 profile page
    0
    Document, document, document.
    I agree with most of the comments, except for refusing assignment. I would take the assignment and ensure that I do everything within my power to be this patient's advocate and safety, as it seems the doctor does not have his head screwed on right. Good luck!
  3. Visit  nurse12b profile page
    0
    Just an update the pt is still alive. The order has been D/C'd since it was taking so long, the family was getting aggravated that the Dr. kept say this it it and everyone would come up to visit him and nothing would happen.
  4. Visit  0402 profile page
    0
    Why would someone write "until death" on any med order? Who gives meds to a dead person? (outside of ACLS stuff- I mean pain meds)
  5. Visit  Munch profile page
    0
    I would definitely check out the comment the doctor made about smothering the patient with a pillow. It's hard to believe the doctor was serious in what he said. Of course the comment should be taken seriously, BUT...a lot of things are said during the heat of the moment. I would certainly make sure that the doctors supervisors are aware of what he is said(and make sure he watches his mouth in the future). As for the medication orders, I do have to say they are bizarre in the way they are timed to be given and the dosage. 1mg of dilaudid seems to me that it isn't enough. If the patient isn't alert enough to be able to use a PCA, then why not use fentanyl TDS with another narcotic used for break-through pain? I know not all medications are effective for EVERY patient..but when my father was on hospice(he had pancreatic cancer which everyone working in healthcare knows is EXTREMELY painful) his doctor but him on fentanyl TDS with 10-12mgs of IV morphine PRN(he wasn't able to have oral medications because he couldn't swallow during the end). My dad responded pretty well with the medication orders. He also was on a benzo(I just don't remember which one). I mean 1mg of dilaudid every hour as well as ativan every half hour is a little ridiculous...who has the time to go medicate a patient every 30 minutes?
  6. Visit  leslie :-D profile page
    0
    Quote from iceecat
    I am not surprised that pharmacy called to clarify the ativan order but for them to suggest to the RN that she did not have to give the med as ordered....I have never met a pharmacist who would suggest that to an RN and it crosses a line for them to suggest that. If the pharmacist has issues with the order than they can hash it out with the MD.
    i disgree, in that it is perfectly appropriate for a pharmacist to tell a nurse they don't have to follow a (questionable) order.
    we don't know if pharmacy addressed concern with physician or not.
    but s/he was certainly not out of line.
    just like it wouldn't be inappropriate for any other licensed professional to offer same type of input.

    Quote from maelstrom143
    Document, document, document.
    I agree with most of the comments, except for refusing assignment. I would take the assignment and ensure that I do everything within my power to be this patient's advocate and safety, as it seems the doctor does not have his head screwed on right. Good luck!
    i only suggested refusing assignment because of the (il)legal implications in assisting someone in murder.
    i was writing/thinking from a defensive point of view.
    if no one questioned this now scheduled order, and had indeed, administered meds til death, then nurse would have been held just as liable as the prescribing physician (if it went to court).
    if nurse refused assignment, s/he would document refusal in nsg notes, with subsequent explanation and intervention...
    i.e., "nm/don notified and aware".
    that type of intervention, is the advocacy the pt needs.
    but to remain in a situation that is dangerous, subjects the nurse to being incriminated as well.

    leslie
  7. Visit  Nebby Nurse profile page
    0
    Sorry but I feel that this is a frustrated family member rather than a nurse. "Adivan'"and "D\C" make me wonder.
  8. Visit  mazy profile page
    2
    Quote from Nebby Nurse
    Sorry but I feel that this is a frustrated family member rather than a nurse. "Adivan'"and "D\C" make me wonder.
    The OP has some eyebrow-raising language. First the order that was written to medicate "until death," something I have never seen written on a TO, in addition to the comment about smothering the patient with a pillow.

    I cannot imagine a scenario where a dr. would put his license in such jeopardy as to make comments like that. Why would a dr. be that invested in a patient death?
    cohrn and


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