IV pain meds standards??????

Nurses Medications

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I have a question. The other night I was taking to my house supervisor about a patient who is a frequent flyer. He is a chronic non compliant patient who always wants the narcs. This hospital doctor hands out the IV morphine and dilaudid like it is candy.

I told her this is not standard practice and she said it was standard. According to our pharmacy, we give more than national average. I told her if the doctors stop handing out the IV narcs then our drug seeking patients would go down to a minimum.

How does your hospital dispense the IV narcs and for what?

I had a patient who was admitted for toe pain (DM) and had a order for dilaudid 2mg q2.

Current practice says we are to accept what the patient says as far as pain goes. So give the med ordered. I still see a lot of patients admitted who are on pain meds at home they take routinely and the dr does not order those meds while the patient is with us. Those meds may be ordered for some chronic pain condition and have that fairly well controlled at home. They come to hospital for some other painful condition and we expect their usual meds to take care of it. Why should we expect that to be true? Besides, maybe the patient has not been correctly diagnosed. Maybe we have just not discovered the cause of their pain. Sometime it takes a long time to get the right diagnosis.

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Specializes in PDN; Burn; Phone triage.
Just give the narcs. You're not going to change them, and they'll make your shift Hades if you don't. An addict will seek their drug/ETOH until they decide to stop, and nothing you do or don't do will change them.

Agree. I've seen some of my fellow coworkers get so incredibly worked up over pts who are probably drug seeking and getting waaaaay too much IVP pain medication. It's just not worth the stress.

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:cat:I think you should first assess the patient's current situation... the source of pain. After assessing the pain educate the patient about the narc you're giving. Some become dependent on pain medications becoz of lack of education on certain thing or situation. After that observe the duration of the medicine you're giving, whether it's inappropriately been taken by the patient for more than it should be. If you think your right, then, coordinate it to the attending physician (in a professional way).

No one can really recognize which person is really in pain bcoz pain is a subjective matter. Don't be judgmental... :shy: I hope this helps...

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my concern here is the statement by the OP that his/her hospital gives out more than the national average. That sounds like an invite for the DEA to come visit. They may want to prune that back a little.

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Specializes in Cath Lab & Interventional Radiology.

I had a patient who was admitted for toe pain (DM) and had a order for dilaudid 2mg q2.

I recently had a patient who was ordered IV dilaudid 2mg q30 minutes. This patient wanted it right at that 30 minute mark every time. I also believe pain is whatever the patient says it is, but that gets pretty ridiculous for time management. This patient was basically getting buzzed, acting like she was high, and giggling even though it was the pts lung that was in pain. Vital signs were stable every time too. It is frustrating when you have other VERY sick patients and 90% of your time is spent with a patient who needs their dilaudid NOW! I almost think the doc was doing it to the nurses to be a jerk. We asked him several times to please change up the pain regiment, because as is getting dilaudid Q30 min the patient never had pain less than 7. He said.. naw I think you nurses can give the dilaudid Q30. I really could barely get one other thing done in her "dilaudid window" & even then the call light would go off to remind me that in 5 min she could get some dilaudid & why don't you bring some lorazepam too? I felt so guilty at the end of my shift that I couldn't care for my other 4 patients better because this patient literally took up most of my time. So I guess I am just saying it is a nice theory to give the pain med whenever the patient asks for it, but in reality it isn't always that easy.

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Specializes in Emergency/Cath Lab.

I actually had a talk with one of our NPs and Docs after a FF rubbed me the wrong way. They basically said it is less of a headache to just give the meds. They risk making the person mad and with how medicine is now, read: business, they can can you for not making the people happy.

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Specializes in Public Health, L&D, NICU.

I have chronic pain, and I hurt at least most of every day and you would never know it just by looking at me. I mask my pain very, very well. Worst of all, my pain doesn't result from some injury, but from a dx that drug seekers love to use. I hate the attitude that so many nurses and doctors have. I shouldn't have to meet some arbitrary standard to convince a healthcare worker that I am, in fact, in pain. It would be wonderful if I turned purple and green when having an exacerabation, but I don't. I don't really care what the nurse's opionion, gut feeling, instinct, or experience tells them about my c/o pain. I say I hurt, therefore I hurt. And if your hospital is giving out IV pain meds, then hallelujah! finally someone and some facility cares enough to treat someone adequately. And no one would suggest withholding antibiotics from a non-compliant patient, so why in the name of all that is holy should it ever be okay to even consider withholding pain meds because someone doesn't act like we think they should?

It sounds like you are on some sort of crusade, going to your superiors and talking to pharmacists. So, what if you succeed? And then someone like me comes in, and is denied something they really need because of it? I would rather have drug seekers lined up and accomodate them than have one person truly in pain be treated shabbily and undermedicated because of incorrect assumptions and perceptions. How does it really hurt you to carry out those orders? Does it come out of your paycheck, does the Pyxis or Accudose require a pint of your blood to get that dilaudid out? Or are you being judgmental and offended because you think your time is wasted?

I rarely go to the ER because of this attitude. I spend time in agony that I shouldn't simply because I know how I will be treated and looked at when I go to the ER and give them my complaint. It is simply awful to hurt so badly that death seems like a relief and then feel like you've got to give a convincing performance in order to avoid the judgment of the nurses and doctors on top of it. No where in a pain assessment does it ask for the nurse's opinion. I feel sorry for any patient with hidden pain that has to deal with you.

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Not sure if you're a nurse or a patient with a grudge and a need to vent because your pain isn't adequately controlled. Nurses sometimes need to vent talk to each other because yep your right we don't have a clue if you are a drug addict or someone who has legitimate pain. I here alot of martyrdom in your little speach. We are not uncaring the problem with most of us is we care too much and deciding if what we carry out as orders is part of the problem or part of the solution. We are just as "entitled" as anyone to give an opinion, as we are human not saints, tho you're right it's usually not documented much less asked for. I personally resent patients who feel so sorry for themselves because the ones they assume are supposed to have all the answers don't, I'm old school and my philosophy has and continues to be is do unto others as I would have done unto me. It is however appropriate for any medical professional to assess their patients needs and discuss it with the MD. Sorry you don't feel comfortable because of someone elses "attitude". I have a ton of experience with people who are legitimate card carrying addicts blame is their number one defense for crappy behavior, but we do put up with it. So if your pain isn't controlled talk to your provider. No one is preventing you nor would they from getting the help you need. Don't assume all ER staff is copping an attitude toward you just because they discuss a difficult situation. ( another symtom of addictive behavior by the way) I don't know you you don't know me in a perfect world everyone would get their needs and wants met with a constant smile on their face, but it's not a perfect world.......

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Specializes in ICU.
I recently had a patient who was ordered IV dilaudid 2mg q30 minutes. This patient wanted it right at that 30 minute mark every time. ... So I guess I am just saying it is a nice theory to give the pain med whenever the patient asks for it, but in reality it isn't always that easy.

Q30min pain meds? Can we say PCA?? That just seems undo-able with 4 other patients...

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Specializes in ICU.
We cannot legally search their bags, we can't go into the bathroom with them, and I have been told that you cannot drug test them on arrival because of HIPAA.

Sorry, but what does that have to do with HIPAA??

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Specializes in Public Health, L&D, NICU.
Not sure if you're a nurse or a patient with a grudge and a need to vent because your pain isn't adequately controlled. Nurses sometimes need to vent talk to each other because yep your right we don't have a clue if you are a drug addict or someone who has legitimate pain. I here alot of martyrdom in your little speach. We are not uncaring the problem with most of us is we care too much and deciding if what we carry out as orders is part of the problem or part of the solution. We are just as "entitled" as anyone to give an opinion, as we are human not saints, tho you're right it's usually not documented much less asked for. I personally resent patients who feel so sorry for themselves because the ones they assume are supposed to have all the answers don't, I'm old school and my philosophy has and continues to be is do unto others as I would have done unto me. It is however appropriate for any medical professional to assess their patients needs and discuss it with the MD. Sorry you don't feel comfortable because of someone elses "attitude". I have a ton of experience with people who are legitimate card carrying addicts blame is their number one defense for crappy behavior, but we do put up with it. So if your pain isn't controlled talk to your provider. No one is preventing you nor would they from getting the help you need. Don't assume all ER staff is copping an attitude toward you just because they discuss a difficult situation. ( another symtom of addictive behavior by the way) I don't know you you don't know me in a perfect world everyone would get their needs and wants met with a constant smile on their face, but it's not a perfect world.......

I am a nurse of 15 years, and my pain is as adequately controlled as it's ever going to get. I understand venting, I do plenty of it myself. But the standards of pain are pretty straightforward. Pain is what a patient says, period, end of story. It is not the nurses role to question it, try to talk the doctor out of treating it, discuss it with pharmacists, etc. The doctor ordered it, just give it. And no, no one physically bars me from entering the ER, but the attitudes on top of everything else make it untenable. I've asked for non-narcotic relief and been told, "Oh, I guess you aren't drug seeking, then!" Well, what if I had asked for narcotic for a pain that was 8/10? That's not an unreasonable request, but apparently that would make me a seeker in that nurse's eyes. I do discuss my issues with my provider, he's wonderful and amazing, but sometimes I have to seek care for flare ups, and there's the rub. Because then I encounter nurses and doctors who don't know me, but assume, from my diagnosis and complaint, that I'm an addict. And that totally goes against everything we are taught in school and the standards Joint Commission sets out for us. And, btw, spellcheck is your friend.

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And no one would suggest withholding antibiotics from a non-compliant patient, so why in the name of all that is holy should it ever be okay to even consider withholding pain meds because someone doesn't act like we think they should?

It's not OK. It's part of the weird morality surrounding opiods in this country.

It sounds like you are on some sort of crusade, going to your superiors and talking to pharmacists. So, what if you succeed? And then someone like me comes in, and is denied something they really need because of it? I would rather have drug seekers lined up and accomodate them than have one person truly in pain be treated shabbily and undermedicated because of incorrect assumptions and perceptions.

I don't see any other ethically defensive stance, particularly since a nurse in a hospital ER is not in a position to "fix" an actual addict. They can, however, cause a lot of damage to those who suffer with pain.

How does it really hurt you to carry out those orders? Does it come out of your paycheck, does the Pyxis or Accudose require a pint of your blood to get that dilaudid out? Or are you being judgmental and offended because you think your time is wasted?

This reminds me of Jefferson's "It neither picks my pocket..." quote.

Once again, it's a moral crusade. I wonder whether the nurse concerned about addiction is as concerned about the adequacy of her patients' nutrition.

True drug seekers will get what they need, though if they get it on the street, there is a greater chance that they will die or contract hepatitis C than if they get what they crave from a hospital. OP, you are doing no one any real favor by tossing seekers out of your ER, while potentially depriving those in pain adequate relief. It's cruel from all angles.

If you want to do some good, OP, don't try to fix the world through your ER job. Learn why drug addiction treatment is so inadequate in the U.S. (and why there are not nearly enough slots for those who would like to get into a program-those are some of the people you see in your ER). This is one area where the U.K. has us beat.

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