Just my hospital?? - page 2
Just the other day, a new policy became official in my hospital. We can no longer give meds on a range schedule. Like 1-2 Percocet Q4 hrs. Now we have to give 1 and then if the pt. needs it we can... Read More
Apr 18, '07Well folks that is what you get when a few "Bean Counters" get out from behind that fat desk of theirs and start writing policies as if they know whats going on in the nursing world..And heck why should we try to use any type of judgement, hey just ask JCAHO..
Apr 18, '07Quote from BULLYDAWGRNHey man...JCAHO knows best! I mean, they are so good, that they can most effectively deal with the personal pain issues of patients' without even seeing them! What do we know?...we only interact with them several times a day, read their histories, etc.Well folks that is what you get when a few "Bean Counters" get out from behind that fat desk of theirs and start writing policies as if they know whats going on in the nursing world..And heck why should we try to use any type of judgement, hey just ask JCAHO..
Apr 18, '07We still do pain ranges - and when a pt gets only 1 percocet, they're only charged for 1 percocet. The pts are billed according to what is taken out of the pyxis. I don't understand how getting rid of ranges helps with pt bills?
And, a pt's pain should be dealt with on an individual basis. Like what the other poster said, a 3 to one person is an 8 to someone else. In addition, pt's change their pain scales on a daily basis. Some get confused and don't even understand the pain scale.
What is this accomplishing? More work for the docs to write detailed orders, more work for the nurse to document, and more limitations for pts to get treated for pain. Not to mention that the nurse will have to chase down docs for new orders even more often - just another way to limit a nurse's ability to actually spend time with the pt. I hope this new concept doesn't come to my hospital for while. This doesn't seem to be helping anyone - did they even think this through?
Apr 18, '07Money and JCAHO....
Money and JCAHO....
Go together like
David Koresh and WACO....
Just once, I would love it if I could get one of these brick-brained dunderheads as a patient with severe unrelenting kidney stone pain....or shooting back pain.....or deep throbbing migraine pain.....
ME: "I'm sorry, sir/maam, I can only give you ONE small pain pill because that is the hospital policy now, because I no longer have a brain and cannot think, see, smell, feel, or hear for myself."
THEM: "pleeeease! my head, heart, back, bones, et al are killing me!!"
ME: "well, you have to wait an hour...I will be back after I finish filling out the six useless forms our hospital says we now have to fill out in order to meet your organization's requirements....please, try to stay calm and enjoy your stay here at blah blah hospital/medical center."
I think these people aren't people....they are evil aliens sent to destroy our sanity.
Apr 18, '07I work nights and usually give 2 in the 1-2 range to aid in sleeping better, ie. not waking up in pain as soon.
Apr 19, '07We still have range orders. I hope my hospital doesn't get rid of them. Yes, we can think critically. JCAHO is a big PIA! You can't lump everyone into the same category. Everyone is unique.
As far as pain meds go everyone reacts differently to them and what kind of pain they are having. A little old lady may do fine with 1 Tylenol and a larger person won't. Personally, when I am giving pain meds I ask the person what they have done in the past or what they generally do at home. I also let that guide me in how I manage their pain.
Yesterday I had an order for 1-2 mg of Ativan because she gets really restless and probably won't be around much longer because she suffered an MI and massive stroke. I hated to see her suffering and knew the previous nurse had been giving 2 mg of Ativan so why would I just want to do 1 mg when I knew she needed 2 mg. Anyways if you are always having to give the smaller amount of range orders I would be wasting a lot of narcotics because we can't get Morphine or Ativan in 1 mg. The smallest vials we have are 2 mg so how are the hospitals saving money with that? I'm sure the patient isn't getting charged for 2 mg if you only give them 1 mg. The hospital is eating that cost, right?
Apr 19, '07Kellykul, the patient is ALWAYS charged for whatever the standard dispensing mg. size is....the hospital will never 'eat' the cost of anything....
they don't care about what you don't give....they only care about what was charged out to the patient...and medicare...ahem.
Apr 19, '07Our hospital still allows ranges like "Percocet 5/325 1-2 tabs po Q4hours prn pain".
That said, we're on the JACHO kick too, so I'm sure it'll change. Of course, where I work, the communication between staff and tptb is so horrible that it'll be months before we find out about new requirements (and then, ONLY becuase some new form will appear nearby) and it'll be only weeks before we're yelled at for not following some new rule we were never told about. Same old, same old.
I'ts enough to make me bang my head against the cement wall each and every shift - think I can get workman's comp for that?
Apr 19, '07Quote from princess_picklejuiceGood point you have there. I am sure it is disguised as a patient safety issue, but clearly these types of orders allow a nurse to use her/his assessment skills to decide which dose would be appropriate for the patient; the new method takes that ability away.Our hospital has eliminated all range orders, dosage or frequency.
Not only that, it applies to meds like Tylenol. No longer can a doc write "Tylenol 1-2 tabs po q4h prn"
Now, there also has to be an indicator such as "Tylenol 1 tab po q4h prn headache" or "Tylenol 2 tabs po prn temp >101 degrees."
This is a JCAHO thing. Apparently JCAHO refuses to acknowledge that nurses have the ability to think critically.
Apr 20, '07The issues we used to have regarding analgesics orders and ranges had to do with the time ranges. For example: oxycodone 5-10 mg q 2-4 hours. What was happening was 10mg would often be given every 2 hours.
Analgesics can still be ordered without a time range. For example: oxycodone 5-10mg q 4 hours. Basically I talk to the patient to clarify what their need is. Some have tried the higher dose first and felt it was too much, others are unsure whether or not they want the higher dose. If they decide they would rather start with a lower dose first, they still have the option of receiving the second pill/dose if necessary.
Apr 20, '07When I last worked in a hospital (2 yrs ago) they had just changed that type of order requirement. The order had to be written:
Percocet 1 tab q4 hrs PO PRN pain
Percocet 2 tabs q4 hrs PO PRN pain. If there was a choice as to frequency, say every 6 hours, instead, they order would have to be entered again for every 6 hours. Since this was an electronic MAR, you conceivably have to search half your available screen to find the appropriate choice. Woe be unto you if you made a choice, and then went to the electronic Narc machine and signed out a the med under a different choice!
What a mess, and we haven't even begun to discuss patient pain management...
Apr 21, '07We have standing orders for Hospice. We might have 3 things listed for a symptom, like constipation. We were asked by a surveyor, "How do the nurses know which med to start with?" They say we are prescribing if we choose which med. The doctor signed the orders, basically saying "I don't care which you give". Sometimes, I would just like to be treated like I have a brain.