Demerol, YUCK!

kewlnurse · Mar 3, 2001

What is the love affair that PMD's and even some general surgeons have with demerol . On our ortho floor is we are not even giving our doctors the option to use it in the new pain management protocol. It doesn't work, gives elderly people narcotic induced psychosis with very little amounts and ust isn't a justifable medication unless the patien is allergic to dilaudid or ms04. Is this just and issue in our area or is this nation/world wide?

sharann, BSN, RN · Mar 4, 2001

Our hospital pharmacist won't even stock our unit w/meperidine without calling us and the doc's if they get an order. The docs are strongly discouraged from even prescribing it d/t the very reasons you cited as well as the fact that it can build up and cause seizures.Demerol is used for some procedures such as Conscious Sedation etc, but generally not. Our new protocol(pain is the 5th vital you know....thanks JHACO) is very against demerol. Try to get your pain management team or experts (you have at least one) to make a form or do a physiscian inservice or something about it. Good subject.

Bye!

sharann, BSN, RN · Mar 4, 2001

Our hospital pharmacist won't even stock our unit w/meperidine without calling us and the doc's if they get an order. The docs are strongly discouraged from even prescribing it d/t the very reasons you cited as well as the fact that it can build up and cause seizures.Demerol is used for some procedures such as Conscious Sedation etc, but generally not. Our new protocol(pain is the 5th vital you know....thanks JHACO) is very against demerol. Try to get your pain management team or experts (you have at least one) to make a form or do a physiscian inservice or something about it. Good subject.

Bye!

TracyRN · Mar 4, 2001

Glad to hear that there are others out there who don't like Demerol. My hospital practically bathes in it. On the same hand, though, I really think MSO4 doesn't do much good, either, on ortho. Makes people "dingy," for want of a better word, and constipated. I'm the queen of warm prune juice down here.

When I work ortho, I go thru the a.m. of 1st day post op, take down the PCAs and start the Percocet. The patients have less nausea, constipation, light-headedness and disorientation. Of course, it does require nursing to be on the spot with PO meds but folks are happier with the PO.

Apparently my pain mgmt team is in the dark ages because they thought they were making great strides ahead by going to a continuous PCA with bolus. I'm so ashamed...

TracyRN · Mar 4, 2001

Glad to hear that there are others out there who don't like Demerol. My hospital practically bathes in it. On the same hand, though, I really think MSO4 doesn't do much good, either, on ortho. Makes people "dingy," for want of a better word, and constipated. I'm the queen of warm prune juice down here.

When I work ortho, I go thru the a.m. of 1st day post op, take down the PCAs and start the Percocet. The patients have less nausea, constipation, light-headedness and disorientation. Of course, it does require nursing to be on the spot with PO meds but folks are happier with the PO.

Apparently my pain mgmt team is in the dark ages because they thought they were making great strides ahead by going to a continuous PCA with bolus. I'm so ashamed...

Doey, BSN, RN · Mar 4, 2001

Kewlnurse, thank-you thank-you thank-you! This has been a pet peeve for me for some time now. I don't know what it is with surgeons and demerol. Do they think it's some kind of miracle drug? There is certaintly a vast array of pharmacologic and non-pharmacologic methods of pain control, all of which are superior to demerol. I absolutely hate using it. No sooner than it's given and the 80yo fresh hip or belly is climbing oob and hallucinating and still not getting adequate pain control. Then the med is d/c'd and of course nothing else is ordered because "we have to let it get out of their system". Other meds are ordered to cover the behavior, ativan or haldol, but again inadequate pain control. When an alternative to demerol is suggested, like morphine etc. the answer seems to always be that the doc doesn't want to decrease their respirations. Nurses are continually being updated on issues re: pain control, proper medicating for ETOH withdrawal etc, but who updates the docs? We have mandatory inservices on these issues and others but it seems like no one tells the docs. To be fair some do take suggestions when they are offered and I guess after 20 nurses throughout the hospital are giving the same spiel they take the hint. But how many patients have to suffer needlessly in the mean time. So this is not just issue in your area. I think it's probably widespread.

Doey, BSN, RN · Mar 4, 2001

Kewlnurse, thank-you thank-you thank-you! This has been a pet peeve for me for some time now. I don't know what it is with surgeons and demerol. Do they think it's some kind of miracle drug? There is certaintly a vast array of pharmacologic and non-pharmacologic methods of pain control, all of which are superior to demerol. I absolutely hate using it. No sooner than it's given and the 80yo fresh hip or belly is climbing oob and hallucinating and still not getting adequate pain control. Then the med is d/c'd and of course nothing else is ordered because "we have to let it get out of their system". Other meds are ordered to cover the behavior, ativan or haldol, but again inadequate pain control. When an alternative to demerol is suggested, like morphine etc. the answer seems to always be that the doc doesn't want to decrease their respirations. Nurses are continually being updated on issues re: pain control, proper medicating for ETOH withdrawal etc, but who updates the docs? We have mandatory inservices on these issues and others but it seems like no one tells the docs. To be fair some do take suggestions when they are offered and I guess after 20 nurses throughout the hospital are giving the same spiel they take the hint. But how many patients have to suffer needlessly in the mean time. So this is not just issue in your area. I think it's probably widespread.

mustangsheba · Mar 4, 2001

It is incredible how pain management differs from hospital to hospital and among geographical areas. Docs get very little education in school about pain. We nurses get far more instruction and, of course, we have to deal with it from hour to hour. How many docs have actually prescribed a pain medication and then evaluated it's effectiveness on at least an hourly basis? Nurses deal directly with pain issues. Doctors write orders and base their decisions on what they learned in medical school and what the pharmaceutical companies tell them. We need to be more assertive in presenting our observations to the docs and provide meticulous narrative documentation regarding what works and what doesn't work. I don't think we can overstate the importance of this issue.

mustangsheba · Mar 4, 2001

It is incredible how pain management differs from hospital to hospital and among geographical areas. Docs get very little education in school about pain. We nurses get far more instruction and, of course, we have to deal with it from hour to hour. How many docs have actually prescribed a pain medication and then evaluated it's effectiveness on at least an hourly basis? Nurses deal directly with pain issues. Doctors write orders and base their decisions on what they learned in medical school and what the pharmaceutical companies tell them. We need to be more assertive in presenting our observations to the docs and provide meticulous narrative documentation regarding what works and what doesn't work. I don't think we can overstate the importance of this issue.

Zee_RN, BSN, RN · Mar 4, 2001

I hate demerol too. We use it ALL the time for post-op pain. And if we do get the occasional MSO4 order, it is 2 mg! Yeesh. Personally, I'm listing Demerol as an ALLERGY and telling everyone my reaction is PROJECTILE VOMITING. Figure no one will want to give it to me 'cause no one will want to clean it up! I think the drug is practically useless.

Zee_RN, BSN, RN · Mar 4, 2001

I hate demerol too. We use it ALL the time for post-op pain. And if we do get the occasional MSO4 order, it is 2 mg! Yeesh. Personally, I'm listing Demerol as an ALLERGY and telling everyone my reaction is PROJECTILE VOMITING. Figure no one will want to give it to me 'cause no one will want to clean it up! I think the drug is practically useless.