23 Employees on Leave from Ohio Hospital after giving Excessive Pain medication

[ClaraRedheart, BSN, RN]

https://www.cnn.com/2019/01/30/health/ohio-fentanyl-death-employees-on-leave/

A quick summary: Several employees are on leave for giving lethal and potentially lethal doses of medication to dying patients. Just curious what hospice nurses think of this! I thought that large doses and morphine drips were fairly common for dying patients. It's not something that I feel comfortable with, I'm med-surg and not hospice, so a bit out of my familiarity and have to seek advice when I get a hospice patient... but thought that it happens fairly frequently. What do you guys think?

[Wuzzie]

2000 mcg of Fentanyl is not comfort care.

[vampiregirl, BSN, RN]

Management of pain and dyspnea can be tricky at end of life. Having worked inpatient hospice I've cared for some patients that have required much larger than typically normal doses of opioids for symptom management.

Patient assessment and monitoring is critical when administering any medication. "Larger" doses should be titrated up slowly to assess what dose a patient needs for effective symptom management. Monitoring of respiratory status should be frequent/ ongoing and other considerations (level of responsiveness, pupil response) also assessed frequently. With palliative and hospice patients, the goal should always be to control symptoms with the minimum amount of medication necessary to control symptoms.

As I nurse, I'm always acutely aware that I am responsible for any medications I'm administering. If I have concerns, I collaborate with a provider prior to administering the medication. I was very familiar with the meds I was administering and have had fairly extensive education about symptom control at end of life. I don't know anything about the nurses who administered the meds in question - so I don't know about the education and experience of the nurses involved. This could definitely be a factor in this story.

Another consideration is that patients approaching end of life can occasionally have rapid changes in condition (such as death) that are unrelated to meds having been administered. However, the number of patients involved in the article certainly concerns me.

I guess what I'm trying to say is that we simply don't have enough information to draw any conclusions. My heart goes out to all those involved though - the staff and the family/ friends of those patients. I can't even imagine what it would be like to have a loved one die of what was originally thought of as a terminal process but then questions arise as to whether the timeline had been manipulated by someone providing orders and/or care.

[Wuzzie]

Not all of the patients were terminal, or receiving end of life care. Regardless 2000 mcg of Fentanyl is so far out of the realm of reasonable dosing even for end of life situations that no amount of explaining is going to matter.

[RNBearColumbus, BSN]

The patient's that died were not hospice patients. Most had recently been taken off vents, and the high doses of fentanyl and other opiates were ordered by the same physician.

According to local news sources, the 23 people that have been suspended were nurses, pharmacists and managers who failed to follow proper procedure for the review and approval of orders.

While we do use morphine and other opiates for control of pain and dyspnea at end of life, the doses are titrated to effect starting with smaller doses, and increasing as needed. We do not immediately start giving huge doses of morphine with the goal of "snowing" the patient or hastening the end of life.

It really makes me sad that people on social media ( and even the mainstream media) have equated the actions of this one doctor with hospice and end of life care.

[Tenebrae, BSN, RN]

On 2/14/2019 at 12:57 PM, Wuzzie said:

2000 mcg of Fentanyl is not comfort care.

Highest dose of fentanyl I've seen used was 600mcg