Administering Narcs and nurse liability

[Jennifer, RN]

So, after a co-worker expressed concerns about one of our ER doctors prescribing high doses of Dilaudid to a patient with chronic abd pain with frequent visits as well as a couple of past visits for polypharmacy drug overdose, I started wondering what our role as the nurse is and what liability do we have.

The patient in question was receiving IM injections of Dilaudid, being continuously monitored on pulse ox and bp (as is our routine for anyone receiving narcotics in the ER).

So, on the nurse's part, she was doing her job of assessment and reassessment of the patient.

Do we as nurses have any say or rights when it comes to narcotic administration that seems inappropriate? Any documented cases that you all know about where a nurse was found negligent for administering large amounts of narcotics?

[TpaRN17]

No reason not to give the meds or to get in trouble as long as you are following orders, administering properly, and monitoring, which it seems that you are doing.

Remember, you don't monitor patients just for the sake of monitoring, you are looking for s/s that the pt is receiving too much medication, like RR too low, too sleepy or difficult to arrouse, BP too low, low O2 saturation level, etc. If these things are out of whack and you still give more meds, then yes, you could get into trouble. If the pt is A&O and vitals WNL, no reason not to give an ordered med.

I see that you have 10 years of experience so I know I'm stating the obvious, but it sounds like you just need a little reassuring that you are doing the right thing.

Ultimately, YOU are giving the drug and as long as YOU are doing the appropriate monitoring of pt condition then the "numbers" don't matter. (See quote above!)

The drug is in YOUR hands (as far as liablitly is concered). You don't feel it is safe to give, don't! Let someone else put that on their hands. Document!

[GM2RN]

Ultimately, YOU are giving the drug and as long as YOU are doing the appropriate monitoring of pt condition then the "numbers" don't matter. (See quote above!)

The drug is in YOUR hands (as far as liablitly is concered). You don't feel it is safe to give, don't! Let someone else put that on their hands. Document!

I don't really get what you are saying, especially as it relates to my post that you quoted.

[TpaRN17]

I don't really get what you are saying, especially as it relates to my post that you quoted.

I thought your advice was great! If it is ordered and the situation is apppropriate, give the med! I wanted to elaborate on the need to use your professional judgment.

[GM2RN]

I thought your advice was great! If it is ordered and the situation is apppropriate, give the med! I wanted to elaborate on the need to use your professional judgment.

LOL Ok, thanks!

[Christy1019, ASN, RN]

Not that i prefer to make a habit of giving high dose narcs to my pts, I have come across some instances where pts have received even higher doses of dilaudid d/t high tolerance and opiod dependence usually related to a chronic condition. I once had a female pt, mid-30s with a hx of very complicated sickle cell that couldn't be on anti-coagulants d/t bleeding out multiple times in the past, who routinely suffered from DVTs, PE, already has had an MI and TIA. she probably weighed 110lbs soaking wet and had already made herself DNR/DNI b/c of the severity of her problems. When she would come in, in a severe crisis, she would be ordered 4mg Dilaudid IVP q15 min x 4 doses, plus 1-2mg ativan b/c she would usually hyperventilate from sobbing so hard. after those four doses she would still be awake, vitals stable, and her pain would only go from 10 to 5/10 . i felt really bad for the woman and had no problem with administering those doses to her (of course i'd be monitoring her), but as i said, not everyone can tolerate the high doses so monitor them closely until you see how they respond.

also, about the patient your post refers to.. did he have a legitimate cause for his abd pain? or was it one of those cases where all the labs/radiology studies come back negative and the doctor is simply giving this dose to shut him up? i just wondered b/c my ER frequently sees people with chronic pancreatitis come in regularly and also receive high dose narcs.