Sorry, I don't know if this should be here or on a palliative care, or where my post should go, but here goes. I work in a 16 to 24 bed hospital depending on the day. Last night we had a bariatric pt come from our LTC facility with pneumonia and in my opinion she was fading fast. We gave her Fentanyl 100mcg S.L. q1h for pain 6 times on an 8 hour shift, the pt was basically comatose prior to the Fentanyl and yet she moaned incessently, which of course bothered the family. The family came out to talk to me and asked "what should we do". The only thing I could come up with was either a Versed infusion or continue what we were doing with the Fentanyl q1h. I told them the benefits and of course the probable outcome and they seemed ok with that. Her respirations were anywhere from 24-36.
During my report this AM, I mentioned that I had talked to the family about terminal sedation and they seemed to be in agreement. There seemed to be a shocked silence in the room at the mere thought I should mention something like this to the family. Did I have the right to have that conversation with the family? The look my head nurse gave me said I should be pushing up daisies. I feel I did the best I could with information I had and the family did seem appreciative