Order that says "Don't call MD for pain meds"?

[Summers3]

Hello!

I recently took care of a pt with a foot fracture and he only had Tylenol for pain. I don't have any experience yet but I feel that this does nothing for pain of a foot fracture. And the pt is complaining that Tylenol does nothing for his pain...... However, there is an order that specifically states "Do not call the on-call MD for pain meds"...... Why? So the MD is aware of the pt's pain.... but does not want to give any other pain meds?

Sorry but I don't understand this situation... why not?

Thanks!

[Tenebrae, BSN, RN]

Indeed, since the OP offered no context whatsoever, the patient in question may well have requested such an order himself.

.

This actually makes sense

I had an addiction to temazepam (same family as valium). Any time i get a new doctor I make a point of telling them under no circumstances should they prescribe me any benzodiazapine, I do it when things are fine so should things not be fine temptation cant even enter into it

It actually paid off several years ago when a doctor tried to prescribe me some valium as a muscle relaxant following a back injury.

[BostonFNP, APRN]

I have written similar orders in the past, and in doing so, I was aware I might be getting a phone call instead of the on-call. I can say that when a note like that is written, it is done for a reason; providers aren't just monsters that want people to suffer and perhaps the short-term pain from a foot fracture is less damaging to a patient than getting re-exposed to pills they previously suffered with.

[Boomer MS, RN]

I have written similar orders in the past, and in doing so, I was aware I might be getting a phone call instead of the on-call. I can say that when a note like that is written, it is done for a reason; providers aren't just monsters that want people to suffer and perhaps the short-term pain from a foot fracture is less damaging to a patient than getting re-exposed to pills they previously suffered with.

If this is one possibility, the issue could easily have been clarified by the MD speaking with the RN taking care of the patient. That would have saved a call to the MD asking for clarification. During subsequent reports, the information could be passed on. It is an unusual order, IMO, but perhaps not without merit.

[Buyer beware, BSN]

The issue of pain control need not be approached as if it were a secret or worse yet a matter of conjecture.

The physician is being a provacateur in this instance by not defining the specific reasons why, I will assume opioids, are out of the question.

Until this issue is resolved it relagates the nurse into a snivelling errand boy/girl and an ineffective, incompetent caregiver in the eyes of the patient whether a drug seeker or not.

After all isn't the issue of pain control and mitigation a HEDIS measure that sooner or later must be addressed and reviewed in the light of day?

[BostonFNP, APRN]

If this is one possibility, the issue could easily have been clarified by the MD speaking with the RN taking care of the patient. That would have saved a call to the MD asking for clarification. During subsequent reports, the information could be passed on. It is an unusual order, IMO, but perhaps not without merit.

Certainly it should have been discussed with the attending RN, I wonder if it was and not communicated at report or if it never was. Would be curious to have the OP provide us some more info.

[Kooky Korky, BSN, RN]

The OP provided no information other than the order in question and the diagnosis ... then asked why such an order would be written. How does one not make assumptions?

My answer to her reflected my experience working with addicts with end-stage AIDS on an inpatient unit during the nineties. That work required that we treat pain effectively and control addiction behaviors at the same time.

Other posters, with different experience, posted different possibilities.

I've been fighting for compassionate and effective pain management since the early 70's. What's striking to me is the fact that these discussions always deteriorate into a big, polarized battle, with one side addressing only addiction and the other addressing only pain. The one thing both sides share is self-righteous outrage.

Of course, the only thing neither side mentions is caring for an active or recovering addict having pain.

Where is the OP, btw?

Even the active or recovering addict can have pain and needs pain control.

Yes, where is OP?

[Kooky Korky, BSN, RN]

I have had several instances where drug seeking behavior has ended up with the pt being unable to obtain anything stronger than Tylenol or ibuprofen. They have ED'd themselves right out of being able to obtain anything stronger at ED's across the city, and sometimes elsewhere. That being said, the best thing is to clarify the order so you do not feel that you have not advocated for this patient, it is all you can do and then you will know the answer to your question. All questions are good questions if unsure, BTW, new or not.

Some who are blacklisted might turn to alcohol. That's not so good either.

At a minimum, whether the patient is forced to "tough it out", as I once heard a doc tell a drinker who asked for pain meds, or whether the pt gets an Rx for real pain med, we should refer to treatment/drug-ETOH rehab and should feel sorry for the human being with whom we are dealing. Life can be very sorry and hard. We need never feel haughty or superior. (not saying you do)

There, but for the grace of God, go you and all the rest of us.

[Boomer MS, RN]

Even the active or recovering addict can have pain and needs pain control.

I wholeheartedly agree.

[heron, ASN, RN]

Even the active or recovering addict can have pain and needs pain control.

Which was exactly my point. Treating pain in someone with addiction issues often requires restrictions like the one in the OP in order to limit staff-splitting and other seeking behaviors.

[Hoosier_RN, MSN]

If a pain clinic is involved, this may be part of their contract as well. Without knowing all of the specifics, its hard to give a definite answer. But I also caught the "do not call the on-call". It doesn't say not to call anybody

[foggnm]

You must be leaving out some other context of the story. Most physicians don't just write orders saying "don't call me for xyz." Read the notes on the patient, their injury, their history, etc and see if there's something more to that order. Physicians generally aren't in the business of letting patients suffer.

[MunoRN, RN]

"Foot fracture" can refer to a wide range of conditions, and not all of them justify the use of opiate pain medications, so it's possible the MD's refusal to write for anything beyond acetaminophen is appropriate.

If it's not appropriate then I don't have any problem calling a Doc to advocate for the patient despite an order not to call them, but I don't think we can assume that's the case based on the information provided.