Delayed pain management before change of shift?

Posted
by kpmadden83 kpmadden83 (New) New Nurse Student

Specializes in pediatric LPN (bridging to RN). Has 2 years experience.

Hello,

I'm wondering if there are any articles (particularly any research papers) discussing delayed pain management (or simply delayed care in general) prior to the change of shift? For instance, a patient asks for some form of analgesia at 6:30 pm and the shift ends at 7:00. Rather than doing it, the nurse leaves it for the following shift. So the patient doesn't get their treatment for another hour.

I'm writing a paper about this and am curious if anyone has any research they've seen they could point me to?

thanks,

--KP

Okami_CCRN, BSN, RN

Specializes in Critical Care. Has 7 years experience. 855 Posts

There probably isn't much, if any research on the topic because it would be inappropriate to withhold pain medication that is requested by the patient solely so that the next shift can give it.

What aspect of the scenario you mentioned is your paper on?

kpmadden83

kpmadden83

Specializes in pediatric LPN (bridging to RN). Has 2 years experience. 5 Posts

37 minutes ago, Okami_CCRN said:

There probably isn't much, if any research on the topic because it would be inappropriate to withhold pain medication that is requested by the patient solely so that the next shift can give it.

What aspect of the scenario you mentioned is your paper on?

Thanks. I'm an LPN bridging for my RN. We're writing a paper and doing a presentation about change, quality care, and/or improvement. It should be based upon something we've seen in clinical or at our jobs. We saw that nurses would delay giving PRN meds (like pain meds) at the end of their shift because they were busy, charting, etc and they would just wait for the nurse on the next shift to give it. I was hoping there would be some sort of research out there about delays in care towards the end of a shift, during change of shift reports, etc.

NRSKarenRN, BSN, RN

Specializes in Vents, Telemetry, Home Care, Home infusion. Has 45 years experience. 11 Articles; 17,510 Posts

Use search term "Delay in pain med administration + nurses"  to find articles.

Had to meet on 2 different occasions with unit administrator to get my husbands q6hr percocet + baclofen dose given around the clock as nurses decided not to awaken him  one time; another change of shift issue which worsened his CVA spasticity--unable to walk for 2 days until given flexoril so share your concern.

HiddenAngels

HiddenAngels

Has 8 years experience. 688 Posts

Hmmm . Devils advocate here. I’m one to wait on giving narcs close to change of shift . I’ll give Tylenol or muscle relaxer PRN but narcs a half hour before I leave. I don’t think so.    Now I will watch the times throughout the shift and adjust so that it doesn’t fall a half hour prior to my leaving. But nope I try not to administer narcs and then leave.
why? Patient’s lie. 
and I won’t be there to advocate for myself. At least if I give it. I’ll be there to still do the follow up pain assessment with the patient to assess their relief.

Do you know how many times I've come in and the patient says the nurse hasn’t given them anything in a while, yet they did right before I started my shift and the patient is swearing to God himself that the nurse did not!  It can be quite a mess. 
Everyone has their own style but I try to organize and watch my times so that narcs don’t lapse during change of shift (before or after)

JBMmom, MSN, NP

Specializes in New Critical care NP, Critical care, Med-surg, LTC. Has 10 years experience. 4 Articles; 2,290 Posts

Change of shift is notoriously a difficult time for many patient care activities like transfers, medications, treatments and even just basic care. It's an unfortunate side effect of trying to wrap everything up to try to get ready to handoff and hopefully get out on time at the same time. It's unfortunate if any aspects of patient are impacted, sometimes this can be addressed by not scheduling medications right around change of shift time, but that doesn't help with PRN medications. Certainly no one wants to leave patients in unalleviated pain, it would be interesting to know what you find in your research- if there is any information out there specifically for this issue. 

Googlenurse

Googlenurse, ASN, BSN, RN

Specializes in Home Health,Peds. Has 18 years experience. 97 Posts

On 11/18/2022 at 1:56 AM, HiddenAngels said:

Hmmm . Devils advocate here. I’m one to wait on giving narcs close to change of shift . I’ll give Tylenol or muscle relaxer PRN but narcs a half hour before I leave. I don’t think so.    Now I will watch the times throughout the shift and adjust so that it doesn’t fall a half hour prior to my leaving. But nope I try not to administer narcs and then leave.
why? Patient’s lie. 
and I won’t be there to advocate for myself. At least if I give it. I’ll be there to still do the follow up pain assessment with the patient to assess their relief.

Do you know how many times I've come in and the patient says the nurse hasn’t given them anything in a while, yet they did right before I started my shift and the patient is swearing to God himself that the nurse did not!  It can be quite a mess. 
Everyone has their own style but I try to organize and watch my times so that narcs don’t lapse during change of shift (before or after)

When a patient claims they didn’t receive any pain meds, I just look at previous shift charting to see if something was given.

 

However, I am noticing in this facility I work at that nurses are signing out of the narc book, but not putting it in on the EMAR. WOW!

I caught a medication error that way before administering a pain medication. The nurse did not put she gave a pain medication in the EMAR, nor did she mention it during report. But she signed out a narc. Now I’m wondering if I should have reported that. 
I notice nurses do that frequently at this facility. 

Okami_CCRN, BSN, RN

Specializes in Critical Care. Has 7 years experience. 855 Posts

16 hours ago, Googlenurse said:

I caught a medication error that way before administering a pain medication. The nurse did not put she gave a pain medication in the EMAR, nor did she mention it during report. But she signed out a narc. Now I’m wondering if I should have reported that. 
I notice nurses do that frequently at this facility. 

What you describe definitely necessitates follow up. In our documentation system when a PRN medication is pulled from Omnicell/Pyxis it shows up in the eMAR as being pulled and "due" to be given. Our expectation is that every medication given be barcode scanned at time of administration. Like you described it is a patient safety concern when someone pulls a medication and gives it without proper administration documentation. 

SharpKid

SharpKid

Specializes in Med-Surg. Has 51 years experience. 3 Posts

I worked on a surgical unit for many years.   Patients often NEED their pain meds when they ask for them.   This was not a problem if it was reported to the next shift.  Later, when admin wanted the effectiveness of the pain med charted, 30 minutes to 1 hour after it was given, many nurses on the next shift refused to do that when making their initial round at the beginning of the shift (within the time parameters) after being asked politely.   "I didn't give it, I not going to spend 1 second charting it".  Occasionally, one of the day shift nurses would stay a few  minutes late, and chart the effectiveness.   Then we would get dinged (if not written up) for charting it after 25-29 minutes instead of 30 minutes.  It was a no-win situation.  This caused some very hard feelings, and many nurses transferred out of Med-Surg.

mmc51264, ADN, BSN, MSN, RN

Specializes in orthopedic; Informatics, diabetes. Has 10 years experience. 3,131 Posts

On 11/18/2022 at 1:56 AM, HiddenAngels said:

But nope I try not to administer narcs and then leave.
why? Patient’s lie. 

The documentation tells you when the pt last had pain meds. I work on and ortho/trauma unit and pain management is key. I always try to make sure my pts are medicated if warranted because sometimes night shift may take longer to get to the pt than is appropriate. 

I hate nothing more than starting my shift with pts that have 10/10 pain and haven't been medicated in a reasonable amount of time. Biggest pet peeve? RNs that move 0600 scheduled meds to 0800 for whatever reason and pain management gets hard to catch up on. 

HiddenAngels

HiddenAngels

Has 8 years experience. 688 Posts

On 11/24/2022 at 12:22 PM, mmc51264 said:

The documentation tells you when the pt last had pain meds. I work on and ortho/trauma unit and pain management is key. I always try to make sure my pts are medicated if warranted because sometimes night shift may take longer to get to the pt than is appropriate. 

I hate nothing more than starting my shift with pts that have 10/10 pain and haven't been medicated in a reasonable amount of time. Biggest pet peeve? RNs that move 0600 scheduled meds to 0800 for whatever reason and pain management gets hard to catch up on. 

Yup and when you leave for the day after CHARTING out and giving the pain meds (I trust you) the patient swears YOU DID NOT! So now I have to page the provider and explain the pain meds that you charted as given that the patient is saying YOU DID NOT GIVE THEM even though your charting says you did.  So here lies a big issue .   Now I have to give a one time dose of something because the patient is swearing you gave him nothing since earlier!! Yes it’s a slippery slope that I choose not to slide on. And for the record.  I would NEVER push the pain meds time back to 8. If anything like I posted I would adjust throughout the night so that they can get them with sufficient relief while we are changing shifts. But I can’t speak for everybody,

chare

3,691 Posts

6 minutes ago, HiddenAngels said:

... I  would NEVER push the pain meds  time back to 8. If anything like I posted I would adjust throughout the night so that they can get them with sufficient relief while we are changing shifts. But I can’t speak for everybody,

You've mentioned this twice.  How exactly are you going to adjust the medication administration times without adjusting the 0800 administration time.

And which EMR are you using.