Do you get "pain med seekers" in hospice?

Trauma Columnist · Sep 2, 2004

Gosh - I would think in hospice where the patients are dying - it wouldn't matter how often they receive pain meds. Yes, patients do build up a tolerance to narcotics, but since they are dying, what is the purpose of not giving them meds - whether it is time or not? I've seen end-of-life patients receive an enormous amount of pain meds - mostly po morphine elixir and ativan. Patients who are expected to have a procedure and go home, like your patients on the med-surg floor certainly need to wean off parenteral pain meds prior to discharge and if they need increasing pain meds, than a proximate cause needs to be looked for. Your hospice patient is different - weaning off meds isn't the focus - their comfort is the only important issue. Good luck with the change...

MandyInMS · Sep 2, 2004

Agree with trauma...hospice=terminal=comfort measures..totally diff from 'drug seeker' pts.

chris_at_lucas_RN, RN · Sep 2, 2004

My question is regarding "pain med seeking" behavior in hospice. Do you get it often? I have the least amount of compassion for these types of patients. That is one of the main reasons I wanted to work at hospice-working with patients who have true need of pain relief, who need me to advocate for them in case they cannot, etc.

I kinda thought if patients say they have pain, they have pain, and we are supposed to treat them, not second guess them. If it's ordered and they ask for it because they have pain, who are we do judge whether they are sufficiently sincere in their need? Aren't we supposed to treat the pain before it gets very bad, so that it doesn't get very bad?

Please understand my term "pain med seeker" to be someone who is obviously timing their meds. I know we are to treat each patient as their pain is real to them, but in reality, much abuse is present in the current hospital setting.

I don't know about abuse in a hospital setting. If someone is in hospital, they are likely uncomfortable. Do you truly want to be responsible for making a judgment call on a patient's comfort? What about the "truly needy" patient who is aware enough of time and spacing and understands aggressive pain management, and thus asks for pain medication when they feel they need it, not waiting until the pain hurts? Aren't they doing what a responsible patient should do, taking an active role in their own care?

I would worry about a nurse taking care of me in my terminal illness who might have some issues with whether or not she felt my pain was severe enough to justify medication--or if I was "seeking pain meds."

We learned a lot about the separation of our own issues from those of our patients, when we were in school. It came under the topic of "ethics." We are not here to control the patient's behavior, we are here to help the patient meet their needs, and when they cannot, to meet those needs for them.

I thought "nursing" wasn't about deciding the patient's needs, I thought it was about assessing their needs. How do you assess pain? We were taught to ask.

txspadequeenRN, BSN, RN · Sep 2, 2004

Remember you are not working in a hospital setting when you are in hospice. Your job as the nurse is to make them comfortable and help them make this transition easier, not to second judge them. Everybody reacts to pain differently and you must grasp that. I have had many patients that I have given PRN Roxanol on a routine basis just to get the pain under control. I have given ungodly amounts of morphine 3 and 4 cc every 15 min (20mg/ml) , but this is normally just in cancer patients. And that is ontop of all the Intensol ,rectal meds and such.. Now of course these are the patients that are close to death..I think hospice is a wonderful are to work,it is one of the places I felt like I have made a difference.:)

fab4fan · Sep 2, 2004

Hello all,
I have finally worked it out to transfer to hospice. I'll be working part time hours there and still 12 hours at my current job on a heavy med-surg floor.
My question is regarding "pain med seeking" behavior in hospice. Do you get it often? I have the least amount of compassion for these types of patients. That is one of the main reasons I wanted to work at hospice-working with patients who have true need of pain relief, who need me to advocate for them in case they cannot, etc.
Please understand my term "pain med seeker" to be someone who is obviously timing their meds. I know we are to treat each patient as their pain is real to them, but in reality, much abuse is present in the current hospital setting.
Please tell me I won't encounter this as much in hospice. That is my true hope in transfering is that I can care for patients as I wish to-and their pain.
Thank you for any replies,
JacelRN

Please, please get the pain mgmt manual by Margo McCaffery and Chris Pasero. You really need to educate yourself on pain mgmt to be effective in hospice.

Please don't allow pts to suffer; get some good references, join HPNA, and listen to your colleagues with more experience.

Not to hurt your feelings, but this post alarms me. Just that comment about having no compassion...sorry, that scares me. It's really not appropriate to be deciding whose pain is "real" and whose is not.

leslie :-D · Sep 2, 2004

honestly?

who cares if they're med seeking?

with the patient being in hospice, them being an addict is a moot point.

and why are they med seeking? are they in physical or emotional pain?

either type of pain is very scary and unnecessary.

they're dying.

give them WHATEVER they want.

this is not the time to judge them.

leslie

KarafromPhilly · Sep 2, 2004

Please understand my term "pain med seeker" to be someone who is obviously timing their meds. I know we are to treat each patient as their pain is real to them, but in reality, much abuse is present in the current hospital setting.

I never understood why pts. are faulted for "timing their meds". If I were in pain, I'd want to know when my meds were "due" so I wouldn't have to suffer for one minute more than absolutely necessary.

aimeee, BSN, RN · Sep 2, 2004

If a person is "timing" their meds and asking for them each time they are due, it is a possible signal for 2 things. First, round the clock pain calls for a long acting med rather than shorting acting. Second, if they are that anxious for their medication, perhaps their pain is being undertreated and they need a higher dose. As mentioned above, they may know that as soon as that dose wears off they begin to hurt and so they are asking for it "on time" to avoid the pain wind up. That doesn't make them a seeker, it makes them a saavy pain manager.

Brickman · Sep 3, 2004

If someone is in the hospice system than I can't imagine why anyone would care how much pain meds they want. If having 6 months or less to live isn't a good reason to be heavily medicated all the time even to the point of being a little high, than what is?

Hellllllo Nurse, BSN, RN · Sep 3, 2004

Please, please get the pain mgmt manual by Margo McCaffery and Chris Pasero. You really need to educate yourself on pain mgmt to be effective in hospice.
Please don't allow pts to suffer; get some good references, join HPNA, and listen to your colleagues with more experience.
Not to hurt your feelings, but this post alarms me. Just that comment about having no compassion...sorry, that scares me. It's really not appropriate to be deciding whose pain is "real" and whose is not.

I agree. I was alarmed by the original post, as well. I worked inpt hospice full time for 4 years. I never remotely suspected that any pt was a drug seeker. And even if they were, so what? It's HOSPICE. If a pt with a huge brain tumor wants ms04 for something other that physical pain- maybe fear, spiritual pain, anxiety, or if they just like the way the ms makes them feel, so be it. Whatever the pt says is pain really is pain. Only in hospice have I seen this actually taken seriously.

I have been falsely accused of being drug seeking by ER personnel and a pharmacist in the past. I was really angered that the unfounded suspicions of cynical staff prevented me from getting pain relief that I desperately needed.

JacelRN, BSN, RN · Sep 3, 2004

First let me clarify.

I have not yet worked in hospice. All my experience is based in Med-Surg. I am moving to hospice so that when I do need to give round the clock meds I can have a clear conscience. And so that I do not feel that the pain meds are abused like it is done so often in my area of current work.

I hope that you can see my true question. I am looking foward to the nursing care of those in need of pain meds to be free of that burden. I believe in it whole-heartidly. That is the reason I am moving to hospice and I wanted a little support from any of those who might have experieced some of what I write.

What you most probably thought from my post was that I was talking about those patients in hospice. I was not. I was directly comparing those in the med-surg setting who are A/O, walk the halls 15+ times a shift, get their Phenergan, Benadryl, Vistaril, and then ask for their IM Morphine because it hurts when they move. Those are the patient's I am directly referring to. On the other hand, those patients who are in pain and don't ask for it but lie moaning in the beds, I educate on the importance of controlling the pain early so as it dosen't get too intense. I am the type of person to advocate FOR pain meds when they are ordered correctly, for the correct reason, for the valid diagnosis, etc.

Have any that have replied ever worked on the type of floor I currently work? Please don't tell me that you haven't seen these types of patients. There are abusive personalities and it dosen't stop in the hospital. I do not feel comfortable supporting drug habits of patients. Even when my patients ask to go out to smoke, I educate them on the importance of not smoking. I assess their needs to find alternatives.

Lastly, I understand that pain is an issue we as nurses are not to judge. I began my nursing career knowing that and I work with that theory every day. Even the "pain med seeking" patients I medicate when they ask for it, every hour if it is ordered and requested. The night I posted I was doing exactly that. I am not one to turn it away. But frankly, it is tiring me out and my compassion for those I work with is slowly deteriorating. I am looking for greener pastures.

I turned to this board for advice and from those of you who tried not to judge ME by my response, thank you. I intend to reasearch hospice, palliative care, etc. For those who are less patient to judge a vulnerable poster, please read this and know I was attempting to clarify and educate myself on an important move both in my career and in my beliefs. I was not presenting a case for debate.

JacelRN