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?
I agree. When a person is admitted for "comfort measures", then give them COMFORT, whether it be narcs or not. We have families not wanting us to put family members on oxygen because they consider it "life support", but when we explain that it's a comfort measure, to help them breath easier and allieve anxiety, they usually agree with us that it's ok. Why should people be so against narcs when it's so obvious that they're needed? If only they could see through the eyes of the patient.
Specializes in Education, Acute, Med/Surg, Tele, etc.
I had a nurse that tried very hard to get all narcotics that were not being used D/C'd so that we didn't have to be responsible for those pills sitting and gathering dust till they were expired. However...they wouldn't be d/c'd if they had been used in three months...and if they needed to be put back into the medication administration...well best be talking to the MD and finding out why all the sudden the pain came back or what is going on...
I felt this to be valid, and safe for all concerned. If a pt needed the narcotic back...I typically did not have a probelm and since narcotics do mask underlying probelms that need to be addressed. So I could get a number of pills untill an MD visit could provide better pain management.
We also started having standard orders...if a PRN medication was not used in 3 months..a nurse may D/C it. That helped soooooo much with pts on mail order or pharm fill that kept getting all these PRNs that were not being used and paying for it all!
If you have some concerns about a narcotic or other PRN that you feel is needed by that pt...you should talk with the RN and make that known...I would also document that you spoke with the RN and the general converstation. That protects you if someone ever askes "and why is this pts pain out of control???".
I always listened to my team...they knew the patients well...and before I ever D/C'd a med...I asked those closest to the pt and the pt about it before I did so! But I know...some places to have a nurse that does that is not as common. So ask your RN or go to the charge RN if you find this to be in violation of a pts rights to pain managment!
Specializes in home health, neuro, palliative care.
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.
This is a HUGE problem. I hear about this all the time. There have even been end-stage cancer patients denied adaquate morphine for fear of 'addiction'. I understand that there is misuse and abuse of opiates, but these drugs are also some of the best we have to improve quality of life.
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?
I work in a LTC facility and state survey just tried to tag us on poorly controlled pain in a res. Long story short we weren't tagged after hours of reviewing the chart but out of this came an inservice of pain from our house MD and instruction to fill in a pain assessment form each time someone received pain prn pain med.
On the concern of addiction the MD said that he honestly has never seen an elderly patient addicted to pain med. A term that is seen with elderly is pseudo-addiction-drug seeking behavior caused by inadequately treated pain. It's our job as nurses to keep our patients at any age as comfortable as possible. Maybe you should request an inservice at your facility on pain.
Having been through knowing about the experience of my Grandmother being denied morphine while in her last stages of cancer of the spine because "she might get addicted", and hearing her screams (mind you, I was 5 years old and can remember it to this day); I say, give 'em what they want. I HAVE to assume that most elderly are in pain from at least arthritis or positional discomfort.
I've fought this issue myself before, and I am not above calling a doc at 3am and waking him up because his patient is screaming in pain. We actually had one resident who was on 75mcg duragesic patch for over a year, fell and broke a hip, was in the hospital for a few days, and came back with nothing but Tylenol. Apparently the MD thought this would be a good time to "get her off of that crap." Then he had the nerve to bless me out for calling him and said that I should have just put the patch on her and called him after 8am to get the order. Ummm.... NO!
This is a major pet peeve of mine too. I had a pt yesterday ...first day I had him but he had been admitted five days ago. He had several major back surgeries that did not turn out well. He had scheduled pain meds but also prn pain med orders. Noone told him that he could also have pain meds as needed. When I told the oncoming nurse this . she said " Oh you had to tell him that...now he will be asking for pain meds all night" I was so irked about that.
I once had a 88 y/o lady who was admitted to the hospital (forgot the exact dx) but the daughter decided that Mama needed to be "detoxed" from pain meds that she had been taking for years and years. And the whimpy doc went along with it....it was pitiful.
The way I look at it, if someone makes it to the late 80's and 90's....give 'em what they want! They deserve it.
For those of you who DC prn pain meds that aren't used very often, how long does it take for the doc to call back and reorder them if the patient c/o pain? How long does the patient need to c/o pain before someone calls?
I dread the day I have to go into a nursing home and have to move Heaven and Earth to get a couple of pain pills.
I agree that everyone should have pain relief. I am lucky enough to work in a facility that is very good about this. We have quite a few residents that are on Roxinal as well as vicodin and ultram. I always do a pain assessment on my residents. Even those residents that are relatively "with it" may forget that they have medication available to them if they are in pain.
If I believe that a patient should be getting pain meds and is not, even though they are ordered, I document what they are saying, and doing, and it is part of my report to the next shift. And, of course I'm going to medicate them (or even wake up a doc if I need to and nothing has been ordered). If it is happening consistently, I question that nurse about the patient's behavior on her shift. Some patients do not require pain meds on all shifts due to a variety of reasons that are legitimate. I would however be concerned if I am seeing someone in pain everytime I work with them on my shift, and note that nothing is given night after night. In LTC, I might even get get the MDS nurse involved if I thought it would help. Pain needs to be addressed. Not doing so is neglect.
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BackInTheGame
33 Posts
I agree. When a person is admitted for "comfort measures", then give them COMFORT, whether it be narcs or not. We have families not wanting us to put family members on oxygen because they consider it "life support", but when we explain that it's a comfort measure, to help them breath easier and allieve anxiety, they usually agree with us that it's ok. Why should people be so against narcs when it's so obvious that they're needed? If only they could see through the eyes of the patient.