Waking resident to give pain injection?

[saustin]

Has anyone ever heard of waking a resident from a restful sleep in order to administer an IM injection for pain? A particularly difficult family has requested that we do this for their father and our DON has gone along with it to keep peace. The resident is able to request pain meds when he needs them and we watch him for any signs of discomfort. He also get Vicodin 10/650 q 4h while awake. The injection he is to receive is Nubain 10mg. with Phenergan 25mg. I strongly believe in adequate pain control but I have a problem with waking someone who is sleeping well to give them an IM injection. I discussed my feelings about this with the DON and she called the physician and got him to okay this for at least 48 hours but I still wonder about any liability that may occur. I would be interested to hear some opinions about this.

THanks!

[canoehead, BSN, RN]

If you must wake the resident why not just give the po med instaed of the injection. And if you are giving a po med, why not a longer acting drug like MS Contin, so you only give the one dose and then just treat breakthrough pain during sleeping time. Seems like the doc hasn't thought through all the alternatives and presented them to the family.

[Sue RN GNC(C)]

Just to throw a wrench into this discussion..

Patients with chronic pain often escape it with sleep. Sleeping is not a indicator of not having pain. Patients with chronic pain have become so used to the pain, they do not know how it feels to not be in pain. Nurses and doctors are legally bound to provide symptom relief - if the patient says they have pain, you simply can not say they don't.

Boy, the stories I could tell:

We admitted a resident who was in end stages of liver ca. She continually denied pain, although she lay in bed all day and ate very little. As a result, she did not get any analgesia to treat pain.

She received a phone call from her daughter one day and I took the cordless phone to her. I stood near by waiting for the phone. I did not eavesdrop, but my ears perked right up when I heard her tell her daughter that she was in pain all the time! That she couldn't eat because she was so nauseated and her abdomen was always "pulling".

When she was finished with the call I sat down with her and told her what I had heard her say. her eyes filled with tears and she told me she did not want to be a bother to us! She was very frightened, but she did not want her family to know how bad it was, and how frightened she was of dying. I held her and we cried together.

I called her doctor and explained the situation. He immediately referred her to our palliative care MD who came by and spoke at length with her. An analgesia regime was developed. Within a few days, our patient was up dancing in the dining room with her son.

She died 1 month later, and the family gave me a picture of her dancing. They thanked me for helping their mom live her last days in comfort and with some measure of peace and happiness as she was able to spend quality time with her family.

So, wake a sleeping patient to give pain medication? IF the family or the patent says they have pain - ABSOLUTELY. (Of course, a SC pump, or fentanyl patch could be in order, be allergies and intolerances also need ot be considered. Even with that, there is often a need for breakthrough analgesia)

[MishlB]

I was always taught to wake patients for thier pain meds...sleeping does not mean pain-free.