Accused of withholding pain medication

[Been there,done that, ASN, RN]

My point....I feel like I "know" this patient from dealing with so very many of his brothers and sisters in Florida (HUGE drug problems!). But there really are several issues in this post.....smoking policy, potential for drug abuse and other dangers while unsupervised, and the pain control issue. As to the latter, I would have given him his meds....but I might have called the doc first to get better orders, if not better meds. This ole' hospice nurse HATES Demerol AND polypharmacy!

To assume the patient was a drug abuser , based on these few sketchy facts...

boggles my mind.

Demerol and Lortab on that schedule nowhere near indicates a tolerance.

How do you feel about 80 mg of morphine an hour? Would you can that a developed tolerance?

It was not. The patient has an enzyme in the brain the works against opioids.

Every patient is different and to make those assumptions is arrogant.

[blondy2061h, MSN, RN]

Is it common to admit patients for IV pain management after an I&D? I don't see many I&D's where I work, but it my primary care clinical we did them outpatient and had people using OTC pain management. I realize that a lip may be a more sensitive area, but I'm just wondering.

[applewhitern, BSN, RN]

About smoking: My hospital is an absolutely tobacco-free facility, meaning smokers can't smoke anywhere on the campus, including their automobiles. If a patient insists on going out to smoke, an AMA form must be signed, and then the patient has to go back through the ER to get re-admitted to the hospital. As you can imagine, we seldom have anyone who wants to smoke that badly!

[toomuchbaloney]

The bottom line here is that the OP is not well versed in pain management.

The OP intentionally did not medicate the patient for pain when medication was requested.

The OP did not attempt to get the medication plan changed when it seemed that the patient had pain when she (in error) believed he could not receive another dose.

The OP is not responsible for discharge of a patient without an appropriate order to do so.

The OP is not responsible for the content or intent of hospital policy regarding smoking, he/she can only advise the patient of policy and then notify management if patient is not compliant.

I continue to be distressed by the number of nurses who seem to have very little information about pain management and the number of patients who suffer because of it.

Yup, to me it sounds like the meds were withheld because the nurse was irritated that the patient didn't do what she said. Punitive. I wouldn't want that nurse caring for me or mine.

[trishmsn]

Every patient is different and to make those assumptions is arrogant.

It is not arrogant, it is assessment. After almost three decades, that skill set is pretty good.

Could I swear this patient had a drug issue? Of COURSE not!! Nor did I state that he was. However, if it walks like a duck and talks like a duck....etc.

(And this is based on behavior, NOT medication intake, which is actually puny...)

[Here.I.Stand, BSN, RN]

(And this is based on behavior, NOT medication intake, which is actually puny...)

What about his behavior, though? That he went outside to smoke? Unwise, yes, but apparently not against hospital policy. That he changed his mind, said he'd be done for the night but then decided he needed pain meds? He can't definitively predict what his pain level will be in 3 hrs. That he reported the OP for withholding pain meds? She did.

[redhead_NURSE98!, ADN, BSN]

About smoking: My hospital is an absolutely tobacco-free facility, meaning smokers can't smoke anywhere on the campus, including their automobiles. If a patient insists on going out to smoke, an AMA form must be signed, and then the patient has to go back through the ER to get re-admitted to the hospital. As you can imagine, we seldom have anyone who wants to smoke that badly!

Pssssh, really? It wouldn't be any sweat off ours' backs. Not like they're paying for any of it anyway.

[Been there,done that, ASN, RN]

Is it common to admit patients for IV pain management after an I&D? I don't see many I&D's where I work, but it my primary care clinical we did them outpatient and had people using OTC pain management. I realize that a lip may be a more sensitive area, but I'm just wondering.

Actually, blondy .. in the world of managed care/reimbursement , an I&D is usually a slam dunk for a full admission. Patients are not admitted for pain control. they are admitted because the surgeon just sliced into a cesspool of infection... opening the door for a septic response.

[Gabby-RN]

Actually, blondy .. in the world of managed care/reimbursement , an I&D is usually a slam dunk for a full admission. Patients are not admitted for pain control. they are admitted because the surgeon just sliced into a cesspool of infection... opening the door for a septic response.

Shame that patients don't opt for the nicotine patch considering or that that are not allowed to smoke while hospitalized.

[RNlove17]

I can't believe pt's can still smoke... all hospital campuses in my area are smoke free.

Anyway, yes it was technically withheld. PRNs are for breakthrough pain. Did I miss something? Why could he not get anymore pain meds till 0700?