Accused of withholding pain medication

[BuckyBadgerRN, ASN, RN]

An I&D on the lip area sounds quite painful

Which makes me wonder why any facility would allow him to step outside to drag smoke across it. Not my facility, but where a close friend works, stepping outside means you've discharged yourself AMA

[morte, LPN, LVN]

I am thinking the Demerol should have been label "until po being taken".....then lortab...

and yes....going out to smoke with venous access isn't going to make me happy, either.

[trishmsn]

I asked him if he was going to go smoke..." He wasn't driving to go have a cig.! What does him going to have a cigarette have to do with giving demerol or not? QUOTE]

Easy....if he became syncopal and hurt himself outside, he could sue for his injuries, claiming he was "overmedicated" and then allowed to go off by himself.

AND.....out of sight with venous access?? Not in any hospital I have ever been in. We would not even discharge patients home with access for home care if we had reason to suspect 'self-medication" IV of heaven-knows-what!

Many hospitals will use a nicotine patch, but if you go out, you are now AMA! If you are mobile enough to go out and smoke, you don't need to be an inpatient....

[klone, MSN, RN]

Agree with the others. You said at the beginning that both meds were for pain. I'm not sure why you're making a distinction between "pain" and "breakthrough pain" - from what I can tell from your post, you medicated him at around 0000 or 0100, then you told him that he'd have to wait until 0700 until his next med (so, either 6 or 7 hours). Not acceptable. I probably would have written you up as well.

[generalRN2008]

My facility states to go at least two hours between meds. It sounds like demorol was around 1am. So you could have given lortab around 3 or 4 am and he could have gotten demerol around 7.

[morte, LPN, LVN]

why is a patient getting iv/im pain med when he can take po? if a walkie talkie requires an EJ, I am going to be questioning IV drug abuse, so no going out!

[imintrouble, BSN, RN]

I suspect withholding the pain meds was a punitive action, decided upon when the pt felt well enough to go out and smoke.

After all, if your lip can pucker up for a cigarette, it can't hurt all that much.

In the past, I've had to fight those judgemental thoughts myself.

The OP has been called out by the patient, and there's no adequate defense for not giving what's ordered.

Where I work, if the patient wanted to make a big enough stink, I'd be afraid for my job. A write up sounds like a gift.

Where I work, patients are allowed to go out to smoke, if accompanied by staff.

[morte, LPN, LVN]

in this case the patient lied, bold facedly so. he should have been discharged on the spot.

I suspect withholding the pain meds was a punitive action, decided upon when the pt felt well enough to go out and smoke.

After all, if your lip can pucker up for a cigarette, it can't hurt all that much.

In the past, I've had to fight those judgemental thoughts myself.

The OP has been called out by the patient, and there's no adequate defense for not giving what's ordered.

Where I work, if the patient wanted to make a big enough stink, I'd be afraid for my job. A write up sounds like a gift.

Where I work, patients are allowed to go out to smoke, if accompanied by staff.

[Pangea Reunited, ASN, RN]

in this case the patient lied, bold facedly so. he should have been discharged on the spot.

If patients got discharged for lying, we'd have very few patients. And in this case, one could argue that the patient simply changed his mind.

[morte, LPN, LVN]

short hand on my part, should have been discharged for going out , not for the lying.

If patients got discharged for lying, we'd have very few patients. And in this case, one could argue that the patient simply changed his mind.

[psu_213, BSN, RN]

If you are mobile enough to go out and smoke, you don't need to be an inpatient....

In this case, perhaps, but I totally disagree with this as a blanket statement. I see patients in my facility walk outside all the time--I'm guessing that not all of them are going to smoke--with multiple infusions running through their central line.

[psu_213, BSN, RN]

Demerol q6 prn, and Lortab q4 prn. He had received Lortab at 2200. At 2400, he was going to leave the floor to smoke, but his EJ access had come out, so it took almost an hour to resite him so he could get his antibiotics. After this was done, he asked for his Demerol. I asked him if he was going to go smoke, and he said that he was through for the night, so I gave him the Demerol.

I was taught that if neither order was written for breakthrough pain, which neither was, you had to wait the time frequency of the last medication received, before giving anything else, to keep from overmedicating someone.

Based on what you were taught, how could you give him the Demerol less that 4 hours after the Lortab was given? If the Lortab was given at 2200, then, as I read the second part that I have quoted, he should not have gotten Demerol until 0200...or am I totally misinterpreting what you were taught? While I am suspicious of this patient, it does not sound like he got adequate pain control. If you were struggling with whether or not you should give another dose of pain medicine (which, for the record, I think you should have), you should have called the doc for clarification of the order.