Giving pain meds.

[banditrn]

I don't know if anyone else will understand my problem or not.

In our LTC facility, we have some patients on PRN Vicodin or Percocet. We have one nurse who trys her darndest to get these things dc'd - she will say that 'they don't need that!'

I understand the problems of addiction, but my thought is - if they're toward the end of their life, why shouldn't they have pain relief?! Tylenol just doesn't do it for some of them.

And (don't hate me) but so what if they DO become addicted? It's not like they'll be standing on the street corner trying to buy it illegally. We have one old guy who asks for a Vicodin every nite at bedtime - that's the only time he takes it - he's unable to move around on his own because of an old hip fracture.

I don't believe in handing it out like candy, but don't they have the same right to pain relief that a hospital pt. has?

[suebird3]

The only way we d/c the order is if it hasn't been given in "x" amount of time. Heck, with the ensuing aches, pains, and cramps of getting old, I would let the orders beeeeee....

Suebird

[1st edition]

I work w/ a fellow nurse who also tries, and sometimes succeeds, in getting PRN's d/c'd at our LTC facility. I feel as you do. GIVE IT TO THEM! They have narcotics med orders on their MAR's for a reason. . . they have mod - severe pain. They have the dx in their chart to prove their pain is real. So what if they are addicted? If giving a pain med makes these elderly folks happy in their last days then I don't have a problem w/ that.

[jetscreamer101]

I don't mind giving narcotics to patients that are in pain. I usually make it a point to ask them if they need pain medication, especially if post-op or terrminal. I don't see the need to keep narcotics in the cart if a resident is not using them. We don't count all controlled substances, just fentanyl, morphine, etc. I have had co-workers in the past that have diverted narcotics. So, if I know there is a pass that isn't being used, I'll try to get it dc'd for non-usage.

[purplemania, BSN, RN]

This points out the need for nurses to be able to assess pain in patients who are non-verbal, have dementia and are elderly. Maybe all at the same time. I do not understand the other nurse's viewpoint, unless she is able to accurately document there is no pain. Everyone deserves to be comfortable.

[dance_200]

I was taught to use pain as a fifth vital sign so i ask them if they are in pain and offer their pain meds to them i dont want to be in pain and i dont want my patients to be in pain. I tend to give more pain meds then some of the older rn's. Now i have to worry about who thinks i am diverting because i am proactive on pain control

[CapeCodMermaid, RN]

You don't count all controlled substances??? We even have to count Ultram now...cripes how do you know someone isn't pocketing?

I've been at my facility for a few short months and am appalled at the lack of pain assessments done. I think the nurses are afraid to give pain meds...or prn psych meds...I've had to go through chart after chart and call doctor after doctor to get some of these meds scheduled. I hope none of these nurses ever know what it's like to be in pain and be at the mercy of someone else for relief!

[leslie :-D]

just because a prn isn't being used, does not mean there aren't pts in pain.

this is a sore spot for me.

if pain asssessments aren't being done (correctly) or if nurses continue to chart "denies pain", then there's a large population that isn't being effectively served.

inservices for proper pain eval need to be mandated.

delusions and misinformation about addiction, a nurses' liability or personal beliefs, have to be discarded.

there is no valid excuse for the suffering many endure at the hands of trained professionals.

no excuse at all.

leslie

[NurseyBaby'05, BSN, RN]

I don't mind giving narcotics to patients that are in pain. I usually make it a point to ask them if they need pain medication, especially if post-op or terrminal. I don't see the need to keep narcotics in the cart if a resident is not using them. We don't count all controlled substances, just fentanyl, morphine, etc. I have had co-workers in the past that have diverted narcotics. So, if I know there is a pass that isn't being used, I'll try to get it dc'd for non-usage.

Not counting narcs is a faulty system. Instead of it being corrected, it's easier to d/c a pt's pain meds???? I'm not that familiar with LTC. I know with us, controlled substances need reordered after one week. Are LTC orders indefinite? It seems like the residents/patients are being penalized for a faulty system where you're at.

[BackInTheGame]

NOT counting narcs??? Never heard that one before. We have a doc that refuses to believe that her patients have pain. We fight tooth and nail and toe to toe with her over this issue. She won't even let us give Ultram without a fight and actually went through the unit one day d/c'ing every pain med on her pts. Unfortunately she is in my doc's practice and occasionally I end up having to see her. She tries to tell me that the NASH I have doesn't cause pain. Yeah right.. let me give it to her for a while and see how SHE feels. Sighhhhh..

I agree though, if a person is nearing end of life.. give them whatever is necessary to ease any discomfort they may have. What's it going to hurt? One kind of funny thing though (not ha ha funny but still... ). Had a pt.. end stage cancer.. refused pain meds because as she put it "I don't want to be one of those junkie people". God love 'em.

[htrn]

My step mother died of pancreatic cancer a few years ago but was afraid to take any narcotcis as she had been sober for 20+ years and did not want to get addicted to anything. It took my father, sister and her doctor quite a while to convince her it was OK to take narcotics to help her with the end.

To allow people to suffer at the end of life in order to prevent addiction is MALPRACTICE in my book.:angryfire

[PhoenixGirl]

I don't see giving percoset q6 as a threat of the patient becoming addicted. Addiction is when drug addicts buy this stuff on the street. In the hospital if someone is used to getting percoset q6 they are building up a tolerance to it and it's not something they are getting "high" from, it's something that works for their pain.

I can't imagine denying some geriatric pt with a bad hip in LTC his pain meds. He's not addicted. He takes a standard dose ordered by his physician. Who are we to withhold that??

Rebecca