Ethics part 2

Specialties NICU


This is going to be my favorite topic with you guys because I often think I work in a science lab.

I had a pt. the other night that perfed and was about 4 days post-op w/ostomy. Obviously in pain w/his belly the size of a basketball. Our fellow did not want to give any morphine and kept mumbling about his blood pressure (which was excellent, considering he had been screaming....) The resident finally got the ok for a small dose which appeared to do nothing for the kid. About 2 hours later, his ostomy bag was leaking and removed and I discovered his wound had dehisced about 3" long. Obviously infected and full of yuckies. Well NO WONDER he was upset. It was horrible. Finally got him another small dose of morphine. Surgery wouldn't come see him at night (and didn't do anything about it the next day) except to tell us to keep it wet w/saline and gauze (might that encourage the yuckies to continue to flourish in there?????) The NP in the am did double his morphine x1 dose but no scheduled order or anything--have to beg each time he starts screaming. So my question is: What would your unit have done for this??? Do I bash my head against the wall alone or are we all in the same boat when it comes to pain management????? If so, is JCAHO (who is so focused on pain control and documentation) just a figment of our imaginations?????

Jolie, BSN

6,375 Posts

Specializes in Maternal - Child Health.

I am fortunate to say that I have never been in your situation. Even when I began in the NICU 17 years ago (in the dark ages of neonatal pain management), our docs were responsive to the babies' needs for pain meds. I have never had to argue the point. I guess I would camp out on the attending's doorstep, or call him/her every 15 minutes until I got a regular order for sufficient pain meds. Bless you for doing your best.

I don't have surgery pts, but it does seem I have to BEG for MSO4 for these kids! Hello!! CRIES is 6!!!!!! It's like spitting in the ocean, but how about Tylenol? And document like crazy and hope JCHAO sees it.

sanakruz, ADN

735 Posts

Nights, right?

Sounds like you are the only one awake enough to care.

Bless you.

No JCAHO is not a figment and it s in place 24/7

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