Narcotics administration - page 2
by schoolmack 17,223 Views | 81 Comments
I work on a med-Surg floor where dilaudid is prescribed excessively. Especially to chronic drug seeking pts. We have joked that we think some of the pts are setting an alarm to wake themselves up so the can request more IV... Read More
- 9Aug 26, '12 by edmiaQuote from schoolmackNo it's not lost. Pain is subjective and your personal feelings/judgments should not play a role in your administration of medication and care of patients. Chronic pain is a different beast, but there's plenty of literature that supports proper pain treatment. If it really worries you, advocate for a pain medicine consult.The concern regarding my first thread is being lost on the dosages of medicine mentioned. I struggle to continue to administer medication to pts setting alarm clocks to receive it vs those that are suffering and apprehensive to take meds.
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- 0Aug 26, '12 by mmc51264When I was in clinical, I saw so many people check out AMA when the docs cut them off narcs. It was ridiculous. Now that I work in rehab, I see a lot of people addicted to vicodin/percocet. they will write down when they got it and will call when their 4/6 hours is "up". I, too, see people that have had both BIL TKR and want nothing but tylenol and others who want 7.5/325 percocet q4. We are supposed to dose per pain scale, but they always say that their pain is 8/9 so they can have 2 when they don't exhibit s/s of that kind of pain. I try to recommend one pill or tylenol, but the ones who know their meds (read: addicts) just want their narcs. Sad really.
- 19Aug 26, '12 by AnoetosEveryone remember what we learned about the ways chronic and acute pain are expressed?
People with chronic, opioid managed pain usually do not seem to be in pain. Pain for them is part of being alive.
Maybe I am naive, but it seems to me that while seekers do exist, we need to be very, very careful in judging them as such.
On this one I am with Sun0408.
- 2Aug 26, '12 by turnforthenurseRNQuote from TheCommuterThis, this and this. Pain is whatever the patient says it is. I find it really hard to believe a patient is c/o 10/10 pain when they are sitting in bed, laughing and talking on the phone, but what am I to judge? As TheCommuter said, as long as their vitals are okay, they are not overly sedated and they are due for their next dose, I will go ahead and medicate them.In this day and age of healthcare where so-called 'customer service' overrules patient care, I've resigned myself to giving patients whatever they request to avoid having any petty complaints lodged against me.
As long as their respiratory rate is at or above a certain threshold and they are not overly sedated, I do not care if they are really in pain. They're getting their narcotics as long as it is time for the next PRN dose.
The nurse is in a no-win situation here. If a patient complains that the nurse did not give the Dilaudid promptly, management blames the nurse for creating a 'poor patient experience' and providing bad 'customer service.'
The whole "customer service overrules patient care" initiative is a bunch of crap, IMO. I recently made a post regarding this. We have had "higher ups" ridicule nurses for not giving pain medication when it is due because the patient was overly sedated. They basically told this nurse, "even if the patient is somnolent, if their pain medication is due you give it to them" because it is better for their Press Ganey scores. It's outrageous. This issue was also discussed in a recent issue of AJN which I thought was interesting. Pain management is one of things measured on the HCAHPS survey but it's a bad measurement tool because sometimes pain control cannot be effectively measured. Look at the chronic pain patients who are sometimes on MULTIPLE narcotics/other sedating meds at once. Sometimes the doctors are to blame - there are some that I have worked with who seem to be afraid to go up on the pain meds for patients who really need them. The article mentioned that a study should be done that shows a positive correlation between increased patient satisfaction and patient safety.
I'm not saying patients shouldn't be satisfied with their "experience." They should be, but safety should trump that, IMO...
- 11Aug 26, '12 by dudette10Quote from AnoetosI'll go one further. Patients who are opioid naive with no chronic pain issues may not seem to be in pain, depending on their personalities and pain tolerance. I am one of them. Post-op, I was ordered morphine 2 mg q2h (refused it most of the time), slept between admin times, and woke up in pain (my fault, not the nurses, due to my refusal) My HR and BP never went above my baseline. Pain was 5/10 at rest and 8-9/10 with movement. The morphine took the edge off, but that was it.People with chronic, opioid managed pain usually do not seem to be in pain. Pain for them is part of being alive.
My pain tolerance is very, very high. My post-op pain experience has taught me to S-T-F-U and push the meds. Pain is what the patient says it is.
- 2Aug 26, '12 by dudette10Quote from schoolmackI don't think it's lost. You mentioned SCC and CA patients. They live with pain and pain exacerbations and are frightened to death of letting their pain get out of control.The concern regarding my first thread is being lost on the dosages of medicine mentioned. I struggle to continue to administer medication to pts setting alarm clocks to receive it vs those that are suffering and apprehensive to take meds.
- 6Aug 26, '12 by sauconyrunneryour point was not lost. You struggle with this because you are putting a value judgement on this, and you are also probably feeling a bit used by the pt as they wait until they can get the next bit of medicine. But thing is it is really hard to tell who is in pain or not. And you don't really need to. I do not waste energy on trying to decided who "deserves" pain meds, or who is actually in pain. As long as it is safe to give and I have an order, I give the medication. I find that I feel a lot less aggravation this way.
- 3Aug 26, '12 by merleeHere is what I know. I have both chronic - diabetic neuropathy - and acute pain. I do what I can to keep my pain at bay. Gabapentin 600 mg q8hr will help me if I LOOK AT THE CLOCK and take it q8. If I am distracted and it gets to be 10 hrs, then my lower legs start burning and pinging, and another 1/2 hour goes by before the med helps.
Muscular and joint pains abound as well, and Ibu 800, or norco 5/325 will be my drug of choice depending on the time of day. And when I was in the hospital I waited 2 hours at one point to get my prescribed meds. My anger didn't help my pain, either.
I sometimes cry at home alone.
- 2Aug 26, '12 by JZ_RNIf a person says they have pain, I don't know if they really do or not, some hide pain, some exaggerate pain, I am not a mind reader.
If you have respirations adequate enough to have a dose, no sleepiness, adequate BP, etc., and are due for a dose, sure.
If you yell at me and demand more or to not dilute or change orders, NO. I will give you what is written and you can discuss with the doctor when they come to see you. Not my job to prescribe or change orders. If someone is in pain and I feel it's legitimate and they ask me like I am a human being and not a slave and a servant, I will call and get orders changed, but this is rarely the situation.
I'm not gonna deny pain meds to someone who says they have pain and who are able to have another dose, both within the order's time frame and physically (respirations, somnolence level, etc).
I also am not gonna be at someone's beck and call for their next fix. You are totally nodding off and have respirations of 9 and your blood pressure is 89/60.. no pain medicine until you wake up, your bp comes up, and you start breathing again, I'll be back to reassess shortly.
If you yell at me and treat me with disrespect though I am not gonna make you first on my pain med rounds (q4 or 6) when I assess pain levels for my patients.
I deserve respect just as I respect my patients and care for their safety, well-being, and about their pain levels. If a patient is honest, respectful, and needs and can have the meds, I give them. If they can't tolerate a dose because of their safety, I hold.
I'm not going to harm a patient to get them high. I'm not going to risk my license for a drug-seeker. I am not going to leave a patient in pain unreasonably if they can have pain medicine.