okay, this could be a stupid question/story, but my degree is not in nursing - i start this summer
so, when i was in the hospital after a c-section (with my 2nd child) and my son was in NICU - i was prescribed to lortabs (2 every four hours). since i was staying in the hospital, i didn't have to go out and get a prescription - the nurse brought it to me...while i was there.
when i had my first child, i was released from the hospital the next day after my c-section - went to the pharmacy, and took MAYBE 5 or 6 pills once i was home. the rest stayed in my med. cabinet.
but with my 2nd child being in NICU and me being stuck at the hospital without being able to breastfeed, hold him, and do all the things new mothers usually do - i was a nervous wreck and stir crazy - wanting to walk to see him, wanting to walk to the ice machine, wanting to put on make up, wanting to go develop pictures - wanting to do ANYTHING besides sit in the hospital bed without my baby!
point being - since i was doing so much running around, i actually needed the pain meds this time. so, after about 6-7 hours without, i asked the nurse if i could have some and she was nice and brought them to me. i suspected that she'd bring me some 4-5 hours later. when she didn't, i asked again. she brought them to me. i asked if they could just bring them to me when they had the chance (around the time i was prescribed) because i would be needing them and i didn't want to bother them - and she said no, and that i had to ask for them. i felt like a drug addict begging for meds every 4-5 hours! i hated it. and after a few times of asking, i felt like THEY were treating me like one!
why do you have to ASK for pain meds in the hospital when they're prescribed after surgery? i'm sure there's a reason - it just made no sense at the time.
Specializes in Nurse Leader specializing in Labor & Delivery.
I think most people in this thread who are saying "PRN means the pt must ask!" are being ridiculous and probably don't understand the subtleties of mother/baby nursing.
Yes, once in a while there are people who are chronic pain medication users (and even then, they still deserve the benefit of pain relief after abdominal surgery, which tends to be exquisitely painful). Generally, these are healthy young women. In addition to recovering from major surgery, they're also adjusting to a major life change and disruption to their routine. They're learning how to breastfeed, as well as take care of a helpless infant. All of these things add up to a lot of pain and stress. If a postpartum mom who just had abdominal surgery asks me to bring in Percocet q4h throughout the night so that she can stay on top of her pain in order to breastfeed her baby and do routine baby care, I have no problems doing that. I asked all the other nurses on my unit after I first read this thread, and they all agreed with me. If the pt requests, no, we are not going to insist that they must ask whenever they want pain meds. We will bring them in q4h if that's what they want (and of course, we will assess their pain level at the time of administration).
Frankly, I think people are just being unreasonable and ornery.
This may have already been mentioned, I didn't read every single post, but the OP states she was given Lortab 2 tabs q 4 prn (Can I just say how much I HATE this order!!!) I would not just bring a pt. 2 Lortab q 4. That would put her over the safe limit for tylenol in 24 hours. I work on a post-op floor and deal with this constantly (I wish we would just do Norco). My pt.s ask me for their Vicoden and I look back to find they got 8 tabs in the last 16 hours and now cannot have anymore. (our pharmacy doesn't flag) So I end up scrambling to call docs for something else (who aren't often quick to call back) while my pt.s sit in pain. Drives me crazy! Especially for pt.s who only want po pain meds or do not have anything else ordered. Had the OP been my patient and was requesting q 4, I would have called a doc to see if we could get something else ordered that didn't have so much tylenol in it.
I try to make it a point to go back around the time pt.s are due for pain meds again. I have had several ask me to just bring them. I tell them I cannot do that (protocol for our unit) but that I will be back to re-assess them close to the time they may be due again and then I go back!!! I also tell my pts. that if for some reason I don't show to please call my phone to remind me and that if I am busy I will find someone else to get their meds. I always remind my pts. that using their call light or my phone is not "bugging" me, but my job. If I have a particularly "stoic" pt. I will make it a point to get back in there to re-assess because I know they won't ask.
OP I did not read your profile, but I am assuming you are not a nurse. I know it seems to you that your nurse didn't have a lot of things to do for you but there is quite a bit that goes on behind the scenes. Monitoring your vital signs, charting, watching lab values etc. that your nurse was doing for you. It sounds like if he/she would have communicated with you a little better this whole situation could have been avoided.
i will admit my thoughts were coming from the perspective of medical/tele pts, not post ops. I agree fresh post op should be reassessed/ reassured that their pain will be controlled.
This may have already been mentioned, I didn't read every single post, but the OP states she was given Lortab 2 tabs q 4 prn (Can I just say how much I HATE this order!!!) I would not just bring a pt. 2 Lortab q 4. That would put her over the safe limit for tylenol in 24 hours.
According the pharmacy director where I work, the FDA's interim response to their advisory committee's recommendation that all vicodin and percocet be pulled from the market is that formulations with greater than 325mg APAP not be used. At my hospital any orders for combinations with greater than 325mg APAP are auto-subbed. If that hasn't happened where you work, you should advocate for that change if possible.
I am a strong advocate for pain control, but I am not just going to give someone carte blanche pain meds just because they demand them that way. I need to assess the patient and the effectiveness of the pain control. Certainly, if the patient needs pain medication, the patient will get it. But I will not routinely bring meds on the q 4h mark ATC just because the patient wants them that way.
We all agree on the need to assess prior to administering pain meds, but if the patient asked for additional pain control in 4 hours, would you at least assess in 4 hours without an additional request at that time? I doubt the patient cares if you have to assess their pain first so long as it's addressed, what we see as a significant difference in protocol, the patient just sees as a difference in semantics. ie; bring-pain-meds-every-4-hours or assess-my-pain-then-treat-if-indicated, I don't care what you call it just do something.
OP, I'm sure that if and when you complete your nursing studies and begin clinical practice as a nurse your view of "assessment" will continue to evolve.
We could continue to debate all day whether or not your pain was adequately "assessed" -- but I would still wonder why, even if the nurse failed to assess whether or not pain was an issue, an alert and oriented patient would fail to state that she was having pain and request meds if that was what the patient wanted.
Good luck to you in your studies.
There are many reasons why an alert and oriented patient doesn't press the call light to ask for pain meds: Some patients see the call light as something to be used only in an emergency, even if we tell them to call for anything. Some patients don't want to be a bother; they know we're busy. Some are old farmers from out in the county who aren't about to admit to what they see as weakness without being asked directly. Some are intimidated by the "we don't take kindly to drug abusers 'round these parts" speech they got from the last nurse. I've found OHS patients in particular don't even realize they are having pain; if you ask what their pain level is they say zero, but if you ask what their discomfort level is they say 10/10, it's only after their first post-op percocet that they realize that was pain after all, now all of a sudden their pulling 1000 on their IS instead of 250 and walking a full lap instead of only making it to the chair and back. In general, some personality types are just aren't forward enough to make the first move to control their pain, particularly with nurses who, lets face it, can be an ornery bunch at times. But that by no means makes them unworthy of pain assessment and control that is in line with their pain characteristics.
I do agree that there needs to be some understanding on the part of the patient, if I assess their pain at 0/10, and half an hour later it's 8/10, I'm probably not going to know that for a while unless they call. I also agree that the patient needs to take as much responsibility as possible in their own care; God helps those who help themselves.
But in the end, it's our responsibility to assess the patient and their diagnosis/Hx and determine what their pain assessment and treatment needs might be and act on that, which is pretty easy in this particular example since the patient told us exactly what they were, and even so we failed in the example given by the OP.
There are many reasons why an alert and oriented patient doesn't press the call light to ask for pain meds: Some patients see the call light as something to be used only in an emergency, even if we tell them to call for anything. Some patients don't want to be a bother; they know we're busy. Some are old farmers from out in the county who aren't about to admit to what they see as weakness without being asked directly. Some are intimidated by the "we don't take kindly to drug abusers 'round these parts" speech they got from the last nurse. I've found OHS patients in particular don't even realize they are having pain; if you ask what their pain level is they say zero, but if you ask what their discomfort level is they say 10/10, it's only after their first post-op percocet that they realize that was pain after all, now all of a sudden their pulling 1000 on their IS instead of 250 and walking a full lap instead of only making it to the chair and back. In general, some personality types are just aren't forward enough to make the first move to control their pain, particularly with nurses who, lets face it, can be an ornery bunch at times. But that by no means makes them unworthy of pain assessment and control that is in line with their pain characteristics.
I do agree that there needs to be some understanding on the part of the patient, if I assess their pain at 0/10, and half an hour later it's 8/10, I'm probably not going to know that for a while unless they call. I also agree that the patient needs to take as much responsibility as possible in their own care; God helps those who help themselves.
But in the end, it's our responsibility to assess the patient and their diagnosis/Hx and determine what their pain assessment and treatment needs might be and act on that, which is pretty easy in this particular example since the patient told us exactly what they were, and even so we failed in the example given by the OP.
This is true. I'm typically a straight forward person who has no problem speaking up under most circumstances, but as I've stated - I just thought it would make it "easier" on the nurse basically. It wasn't to sabotage the policies, get the nurse to go against procedures, or not go one minute past the point of when I "could" be given more.
Just to clarify, many people seem to think I requested to be brought medication every 4 hours around the clock. That wasn't the case as I didn't even know that I could have them every four hours, and had waited longer than 4 hours on the occassions I requested them. I learned that I COULD have them every four hours IF I needed them. I was told this AFTER I suggested her just bringing them to me because I had NO idea when I could have more. For all I knew, it was every 8 hours - I wasn't (and still am not) a nurse. I think that's something else people forget when dealing with pts is that they have zero knowledge about when it's even reasonable to want/need more by medical standards.
I just think, in my self righteous opinion, it would be better/easier for the nurse and the pt for the nurse to say, "You may have more in X hour intervals. You may not need them exactly every X hour, but you can not have them before that." That way people aren't requesting meds before they are due (and that was NOT my case) and they aren't lying in pain because they're afraid to speak up from fear of being deemed a "drug seeker" when in reality they could've had more several hours ago if they had any clue it wouldn't be unreasonable to ask.
However, after reading, it seems as though if the nurse is doing things correctly, a patient shouldn't have to let several hours pass past the point they were due because the nurse would check in and assess the patient which would open up an opportunity to request medication in response to being asked about the pain.
I mentioned some of my experiences with people being accused of being "drug seekers" including my step-father who is most certainly not. He told practically everyone about it because anyone who knows him would find that hysterical. Furthermore, the hospital emergency rooms have signs posted (i've seen when taking my children) that say something about narcotics which I can't say what it says word for word, but basically is directed toward people who visit the ER within a certain time frame seeking medication, and it won't be re-ordered if it's lost/stolen, etc, etc. Pain medication abuse is a huge problem where I live and unfortunately I think it affects the way patients are treated even when they have legitimate pain.
The only real impression that I get is that the OP came here simply to reinforce her thoughts, and not to receive perspective from any other direction. Anything stated to the contrary of her opinion was not taken in the light in which it was intended. If you don't really have a question, don't "ask" one.
As far as sissykim's post about AA and pain management, she has posted on other threads clearly stating her opinion that AA's are treated poorly in healthcare and all are discriminated against. Don't bother taking a bite out of THAT apple, it'll never be a constructive conversation.
The only real impression that I get is that the OP came here simply to reinforce her thoughts, and not to receive perspective from any other direction. Anything stated to the contrary of her opinion was not taken in the light in which it was intended. If you don't really have a question, don't "ask" one.
As far as sissykim's post about AA and pain management, she has posted on other threads clearly stating her opinion that AA's are treated poorly in healthcare and all are discriminated against. Don't bother taking a bite out of THAT apple, it'll never be a constructive conversation.
i thought it was silly to begin with, but wanted to know what the reason for the silliness might be. had there been some strict, unavoidable reason for it - i may have changed my mind. i didn't change my mind because the majority of people responding confirmed that it could/should be avoided simply by assessing and asking a simple, routine question.
the only real impression i get is that THIS is what you really wanted to say, and i was just a scapegoat/good opportunity for an intro:
As far as sissykim's post about AA and pain management, she has posted on other threads clearly stating her opinion that AA's are treated poorly in healthcare and all are discriminated against. Don't bother taking a bite out of THAT apple, it'll never be a constructive conversation.
Certainly it's unfortunate that the way standing and PRN orders work wasn't explained to you at the time, which would have potentially alleivated this distressing aspect of what was undoubtedly an upsetting and stressful post-natal experience.
I appreciate that your idea was that making a request to receive your PRN meds regularly would make your nurses' lives easier; as the responses you've received demonstrate, that wouldn't have been the case. However, I am a little concerned that, despite the numerous explanations of PRN, you still write:
However, after reading, it seems as though if the nurse is doing things correctly, a patient shouldn't have to let several hours pass past the point they were due because the nurse would check in and assess the patient which would open up an opportunity to request medication in response to being asked about the pain.
I wholly agree that all patients, regardless of whether or not they've had surgery, should be regularly assessed for pain. But there is no "due" for PRN medications. Many of my patients have PRN orders that are unused for days, sometimes even for their entire admission.
I thank you for bringing to my attention this reminder that the fact about aspects of the in-patient experience that are routine to me are often novel and unknown to my patients. I'll be incorporating this aspect of care into my future patient education.
Wow...all I can say is WOW! No actually, I can say more...It amazes me how high and mighty some of you sound in regards to issues that weren't even in the OP's post. This has sadly become so twisted and far from what was originally asked. As just a lowly student, I got to say it's embarrassing to see some of you "professionals" behaving so UNprofessional. I'm learning a lot on these boards, and sadly some of that knowledge is how NOT to act after I get my license.
Specializes in Nurse Leader specializing in Labor & Delivery.
Wow...all I can say is WOW! No actually, I can say more...It amazes me how high and mighty some of you sound in regards to issues that weren't even in the OP's post. This has sadly become so twisted and far from what was originally asked. As just a lowly student, I got to say it's embarrassing to see some of you "professionals" behaving so UNprofessional. I'm learning a lot on these boards, and sadly some of that knowledge is how NOT to act after I get my license.
Can you be more specific as to what exactly you're rebutting? Your post is very vague, and I have no idea what "side" you're even on.
klone, MSN, RN
14,857 Posts
I think most people in this thread who are saying "PRN means the pt must ask!" are being ridiculous and probably don't understand the subtleties of mother/baby nursing.
Yes, once in a while there are people who are chronic pain medication users (and even then, they still deserve the benefit of pain relief after abdominal surgery, which tends to be exquisitely painful). Generally, these are healthy young women. In addition to recovering from major surgery, they're also adjusting to a major life change and disruption to their routine. They're learning how to breastfeed, as well as take care of a helpless infant. All of these things add up to a lot of pain and stress. If a postpartum mom who just had abdominal surgery asks me to bring in Percocet q4h throughout the night so that she can stay on top of her pain in order to breastfeed her baby and do routine baby care, I have no problems doing that. I asked all the other nurses on my unit after I first read this thread, and they all agreed with me. If the pt requests, no, we are not going to insist that they must ask whenever they want pain meds. We will bring them in q4h if that's what they want (and of course, we will assess their pain level at the time of administration).
Frankly, I think people are just being unreasonable and ornery.