I always dilute morphine and dilaudid- the extra mls in the syringe help me to administer it slowly (over two minutes) - especially with a peripheral. With ativan, I dilute a bit more than the 1mg/ml recommendation.
I have had so, so many experiences of patients bullying me about this practice/ my narcotic administration in general - I hear this constantly:
* "no one has ever diluted my meds"
* "it didn't help my pain- I think it is because you diluted it"
* (with IVF running) "you have to flush afterward, or it won't work"
* "it won't work if you push it that slow- two minutes is too long"
I tell them that they are getting the same amount if medication. I tell them that I administer it at the speed per our policy, blah blah blah- but still- they are angry. I even had a 25 year old patients MOTHER reprimand me about this the other day.
At what point do you cave in for patient satisfaction? I always give it over two minutes regardless of how upset they get... I guess I'm just curious how you all handle this situation. Thanks!!
PBeing a nurse with chronic pain this is hard for me. I often gave the same speech on they were getting the same amount, etc until an inpatient stay changed my mind on this subject.together the nurses, dr and I found a good regimen that worked well.until a nurse came on for his 12 hour day shift. Suddenly my pain was not being relieved.well at all. I made sure the dose and med was the same but all day I was in a lot of pain. On the last push of his shift i and the ruse he was giving report to on me noticed he had diluted the. 1mg of dilaudid in a rather large amount of saline(I'm not sure howuch exactly sn was used to dilute as I didntt notice until the coming on nurse asked if i had bad veins or why was he diluting it so much. As soon as the next night dose was given not diluted but pushed slow the normal pain relief came back. I will forever be convinced diluting narcotics can effect efficacy. I'm still carful not to push to fast as nobody wants vomit or bad stats to deal with but i just flush if needed rather than dilute. (My screed name notaseeker comes from being accused of seeking drugs and bc I know medical info & terminologyI have bn told nurses get addicted often" and finding pain mang. As a nurse is hard too
PBeing a nurse with chronic pain this is hard for me. I often gave the same speech on they were getting the same amount, etc until an inpatient stay changed my mind on this subject.together the nurses, dr and I found a good regimen that worked well.until a nurse came on for his 12 hour day shift. Suddenly my pain was not being relieved.well at all. I made sure the dose and med was the same but all day I was in a lot of pain. On the last push of his shift i and the ruse he was giving report to on me noticed he had diluted the. 1mg of dilaudid in a rather large amount of saline(I'm not sure howuch exactly sn was used to dilute as I didntt notice until the coming on nurse asked if i had bad veins or why was he diluting it so much. As soon as the next night dose was given not diluted but pushed slow the normal pain relief came back. I will forever be convinced diluting narcotics can effect efficacy. I'm still carful not to push to fast as nobody wants vomit or bad stats to deal with but i just flush if needed rather than dilute. (My screed name notaseeker comes from being accused of seeking drugs and bc I know medical info & terminologyI have bn told nurses get addicted often" and finding pain mang. As a nurse is hard too
And....it could have been that the particular nurse was diverting? Davis' Drug Guide states to dilute in AT LEAST 5 ml sterile h20 or NS. Same volume of diluent is advised for morphine.
In my 40 + years of nursing, I have learned to figure out the difference between the patients issues, and mine. When I am doing something just so the patient will not be in control, I have lost my reasons for being a nurse. My job is to provide the best care that I can within certain perimeters set by the physician, hospital policy, and my best practice. My mission is to integrate what i know, and what I have experienced to do the best for my patient. If I make it my business to intervene on someones drug addiction, while also trying to manage their pain, I have set forth an impossible task. So I try to step back, let go of my need to control (or punish) the patient, and do what I believe is best, without judgement or rancor. My anger, need to control, or judgement never helped anyone get better, or manage their pain.
I always dilute all IV narcotics in 10 mls NS and try to push slowly, but I am probably guilty of being shy of a full two minutes when I push- so much to do and so little time.
Specializes in Psych, Addictions, SOL (Student of Life).
In my 40 + years of nursing, I have learned to figure out the difference between the patients issues, and mine. When I am doing something just so the patient will not be in control, I have lost my reasons for being a nurse. My job is to provide the best care that I can within certain perimeters set by the physician, hospital policy, and my best practice. My mission is to integrate what i know, and what I have experienced to do the best for my patient. If I make it my business to intervene on someones drug addiction, while also trying to manage their pain, I have set forth an impossible task. So I try to step back, let go of my need to control (or punish) the patient, and do what I believe is best, without judgement or rancor. My anger, need to control, or judgement never helped anyone get better, or manage their pain.
I like this response because at the point that a patient is in the hospital is not a time to attempt detox. Acute medical hospital's are not detox/rehab centers and nurses are not diagnosticians so you take care of the patient and not make value judgements about med-seeking addictive behavior.
I dilute with 2 or 3 mls of nss and push according to the dose and pt. If they are an addict who is not opiate naive (sp?) I push fast because if I push slow, they say that their pain is not relieved and I and up calling the doc for an extra dose anyway. Little old lady who never even took Tylenol, I'm pushing over 2-3
Notaseeker
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PBeing a nurse with chronic pain this is hard for me. I often gave the same speech on they were getting the same amount, etc until an inpatient stay changed my mind on this subject.together the nurses, dr and I found a good regimen that worked well.until a nurse came on for his 12 hour day shift. Suddenly my pain was not being relieved.well at all. I made sure the dose and med was the same but all day I was in a lot of pain. On the last push of his shift i and the ruse he was giving report to on me noticed he had diluted the. 1mg of dilaudid in a rather large amount of saline(I'm not sure howuch exactly sn was used to dilute as I didntt notice until the coming on nurse asked if i had bad veins or why was he diluting it so much. As soon as the next night dose was given not diluted but pushed slow the normal pain relief came back. I will forever be convinced diluting narcotics can effect efficacy. I'm still carful not to push to fast as nobody wants vomit or bad stats to deal with but i just flush if needed rather than dilute. (My screed name notaseeker comes from being accused of seeking drugs and bc I know medical info & terminologyI have bn told nurses get addicted often" and finding pain mang. As a nurse is hard too