I am Charge RN on a 26 bed Med/Surg unit. I was accused of withholding a patient's pain medication. Here's the situation. I would appreciate hearing how other nurses interpret this situation.
The patient had a lip abcess I&D'd. He had two PRN pain medication orders. 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. About 30 minutes later, he was going to smoke. I advised him of the risks, but he went anyway! When he returned, I told him that it would be 0700 before he could get anything else. About 0300, he was asking for the Lortab.
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.
Thatmorning, he complained that I had withheld his pain medication. I was written up for this. My nurse director said that I should have given the medications 'as ordered'. I attempted to explain to her how meds are given, if neither are for breakthrough pain. All she said was, 'what is the policy?' She could not even tell me. I have not had the chance to see if my facility has a clear policy on this.
Please let me hear some perspective on this. I feel I carried out the orders correctly. It would be great if someone could direct me to a definitive policy on this.
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
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....
Specializes in Nurse Leader specializing in Labor & Delivery.
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.
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.
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!
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.
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.
BuckyBadgerRN, ASN, RN
3,520 Posts
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