pain control

[zelda]

In our facility we have several nurses and med aides who are not educated enough on pain control in the elderly. If pain medications are not written on a routine schedule, they usually are not given, either because pain is not identified, or because it is just forgotten. I am a strong advocate and feel that our elderly are undermedicated for pain. I frequently used the prn order written by the physicain and using the parameters given, set up times on the medex so pain meds would be given routinely. Usually the order from the physician was for every 4 hours prn and I set them up on BID doses. As we all know, physicians also undermedicate for pain and it is difficult to get a routine order sometimes! During our last annual survey I was criticized heavily and was even said to be prescribing medications under a nurses license by a state inspector. I no longer do this and now we are again having difficulties with adequate pain control. Was I actually prescribing medications? Would like any responses on this and also would like any advice available on how others are managing pain with our elderly population.

[kids]

Originally posted by aimeee

...

Darvocet! Bah! Barely more effective than Tylenol and yet high potential for poor tolerance. Most patients in LTC would be better served by a different med.

Also has a VERY high incidence of confusion and falls in the elderly...is on the no-no list in WA state.

[aimeee, BSN, RN]

Originally posted by cargal

Aimee,

Thanks for the tip, but the arrogant MD is the medical director. He is so freakin full of himself. But anyway, thanks for the support, will stay on it!

Oh NO! Gotta find a way to make the change seem like his idea. Don't ask me how!

[LilgirlRN, ADN, RN]

When JCAHO came around last year, that's what they pounced on at my hospital, better pain control for the patients. I work in the ER, many of our patients are there just for that, pain control. I work with one doc who routinely orders 12.5 mg of demerol Iv for patients with a kidney stone! I stay on him until I can get my patient comfortable. Every doctor should have to have some kinda major pain so they can understand. This doc will admit he can't relate cause he's never had to deal with pain himself. Fot those of us who have had kidney stones, I think I can say I wouldn't want him treating us.

[Aerolizing]

I work in a long term facility. We call in hospice for our folks with end of life pain control issues and they do a wonderful job getting pain meds ordered. We also tend to use a lot of transdermal patches (fentanyl)sp?. They last for three days and seem to help with pain control without having to give prns every four or so hours. We also have some of our folks on straight orders for tylenol. We too, evaluate pain control for our folks who are falling. When we medicate for agitation, we assess for last bowel movements, hunger, and pain. A protocol for pain assessment would be wonderful. We give a lot of prn pain meds and I hope we are doing an adequate job to control pain.

I have found that encouraging our folks family members to be advocates when we have failed helps also. We are lucky, our residents do not have to use our facility's contracted docs if they don't want to and I never forget to mention that to family members if they are unhappy with their loved one's pain control.