My situation is this....
I recently medicated a pt with IVP Dilaudid 2mg (as ordered) for a pain scale of 10/10, at the same time I also gave 2 Percocet 5/325. The pt had an ACDF two days prior and was having continued pain issues that the MD ordered a CT of the cervical spine, which was positive, so a PCDF was scheduled within 48 hrs. Pt experienced N/T to BUE and foot drop in LLE. The pt tolerated this regime without complications as he has prior history of narcotic use.
Regardless, I had been taught by one of our physisicans that this is acceptable practice to assist in "getting ahead" of pain. The rationale here is that when the IVP Dilaudid begins to wear off, the Percocet is beginning to work. Allowing the pt to experience a decrease in pain.
Well, I had an experienced RN (as I am a New Graduate, practicing for the last 8 months) explain that this is poor practice and VERY dangerous. I was explained that the Percocet should be given, then if the pt continues to complain of pain in 40min, then I should have given the IVP Dilaudid for the breakthrough pain.
The rationale for this is: to give the pill a chance to work, then if it does not, then give the IVP medication.
This really seems odd to me,
Would both medications peak at the same time? Increasing the risk of oversedation and possible need to Narcan?
I really need to clarify... The doctor's rationale makes sense to me as well as the fact that I understand the peak times of such medications. I am concerned about the latter practice, from the experienced RN, as I feel this may cause oversedation and possibly a need to Narcan a pt. Which, at our facility any Narcan reversal is an automatic ICU admission. I would hate to make such mistake, then cause a pt to be transferred unneccesarily to the ICU.
I want to do the right thing and to be safe for me, the facility, and especially the pt. In this situation, the pt never had any complications, was happy with my treatment and requested the previous nurse not return, then the pt began to need less and less medication over time. Things worked out this time, but I need to know if this is a good practice or if the experienced RN is really right and I should follow her advice (by the way, she is a charge RN too).