Why does a nurse not give narc. Early

[KB18fan]

There is a patient that curses when he only gets one of his narcotics and not both when one is scheduled every 12 and the other is not every 4 and I tell him he has to wait at least an hr or 2 after the last dose. Why can't he get them at both when the come due at same time?

Oxymorphone 30mg 1 every 12

Oxycodone 30 mg every 4 hrs as needed

Nurse.. Was told he has high tolerance.

Patient. 21 hip surgeries mrsa 4 times he has mrsa now

Ps he has another thread to write. Hard to understand cause he has

Comprehension issues

[TriciaJ, RN]

The patient might have severe pain issues and a very high narcotic tolerance. That doesn't change the fact that the drugs have dangers associated with them and need to be administered with caution. Maybe the nurse is being overly cautious. Maybe there is a doctor's order not to administer concurrently. There might be a lot of factors that you don't know about, and I certainly don't know about since I'm not there.

The bottom line is that the nurse doesn't want to kill the patient. Any other speculations are based on not enough information and are inappropriate.

[AceOfHearts<3]

The scheduled q12 hour med is a long acting med and the q4 hours med is for breakthrough pain. Perhaps there is a policy about not giving long acting meds and meds for breakthrough pain together.

I would do my best to not have them line up to be given at the same time as that would defeat the purpose of having a med for breakthrough pain.

[calivianya, BSN, RN]

I usually give that kind of stuff together. Since the Opana is extended release (at least I'm assuming so from the dose), my thought process is to give them together, so the instant release med can knock the edge off while the extended release med has a chance to start working.

I usually give IV fentanyl and PO hydrocodone at the same time for this reason, too, if they're both ordered. Fentanyl has a very short half life (we can dose every 15 minutes in my unit per our pain protocol), so by the time it's wearing off, the PO meds will start kicking in.

However, I work in a very highly monitored area. My patients are hooked up to continuous telemetry and pulse ox monitoring, and it's not at some central monitor - the monitors can be seen at the pod where I sit, in the patient's room, and at the nurses' station. If I couldn't see immediate changes in pulse ox, or couldn't monitor my patient very closely after I give that much medicine, I probably wouldn't be so liberal with my narcs either.

We also have narcan built into our pain protocol, so if I had to call to get some instead of just being able to pull it out of the Pyxis like any other med on the patient's protocol, I would probably also think twice. For the record, I've never had to give narcan because of something I've given in my four years as a nurse, but knowing I have that safety net also makes me feel free to make sure the patient's pain is adequately controlled.

Not everyone has access to such liberal amounts of pain meds, and also easy access to reversal agents... so I totally understand why some people are leery of giving multiple kinds of narcs together.