Have you ever heard of vicodin making pt too sleepy so changing to fentanyl patch???

[AtlantaRN, RN]

Question, patient with multiple wounds, but feeds self, eats well. Owner of care home states vicodin "knocks pt out", so

produces a prescription for fentanyl 75 mcg??? i asked medical director, he said change vicodin 5/500 down to lortab 2.5/500;

also owner of care home states "your marketer said you would pay for her vitamins...." I asked branch manager---no freakn way.... Anywhoo, family member and patient are just so nice to deal with but personal care home owner demands everything! We have NEVER paid for vitamin supplements....we're not talking just normal vitamins-but juven and promod....quite expensive. IMHO, if patient eats well- how about not feeding patient chili dogs and french fries and actually feeding meat and vegetables.......thank you for listening-I do not look forward to this visit today.

I can't even find a converstion from vicodin to fentanyl patch.....from fentanyl iv to vicodin it lists fentanyl as 15000000mg stronger than a vicodin, but i suppose that is divided by 72 hours.......it seems like we are going from a hand file, to a mill lathe LOL

[leslie :-D]

i have to wonder if owner is thinking of use for himself (too?)

it's very suspect.

how did he come up with fentanyl and its dose???

leslie

eta: i've heard of vicodin making some sleepy...

but never, ever heard of changing to a much more potent narc.

[caliotter3]

The first thought when reading your post is that the owner wanted the fentanyl for himself. Just too obvious to me.

[AtlantaRN, RN]

she produced a prescription dated 4 days prior to hospice admission, saying she didn't want family to have to pay for it....since she was going on hospice. When she said vicodin made pt too sleepy, i talked to med director and cut dose in half from 5/500 to lortab 2.5. I saw owner today, told her cut dose in half, i had it delivered by our pharmacy by courier. She said she "would not give" because made too sleepy.....??????? how does she know?????? she did say today "she wasn't on vicodin before", when i have a printout from a local rehab hospital saying she was on vicodin 5/500 qid prn pain. pt has a stage IV to sacrum and 5 other decubitus....pt does not complain of pain. Patient and family is great, but i really don't know where this administrators head is at.....

thank you all for comments, i know something is not right with this situation...

[leslie :-D]

what does the pt say about vicodin?

would she agree trying half the dose?

i guess i'm trying to figure out, why this 'admin' is speaking on behalf of pt?

and, did you inform this lady, that changing vicodin 5mg to fentanyl 75mcg, will NEVER happen?

leslie

[AtlantaRN, RN]

oh yes, told her that patient must be tolerant to 60mg morphine daily to justify changing to a 25mcg fentanyl patch according to the duragesic package insert (found online). Patient says she isn't hurting....I was just following what hospital dc orders stated, and she does have 6 pressure ulcers, the greatest is a stage IV sacrum.....

[AtlantaRN, RN]

we've dealt with this facility before, the administrator (with the last patient we had there), was wanting me to decrease patients keppra that she had just started on saying "at the hospital she was way too sedated," I told her, then, that I had not even laid hands on this patient yet-so certainly i will take sedation over seizure activity because sedation will not kill her..... She speaks on behalf of the patients over the families....and I don't know why-but they let her

[AtlantaRN, RN]

patient states no pain, patients niece defers to administrator.

pt with a dementia history, able to make needs known, said she would try medication, but says not hurting.....

[Hospice Nurse LPN, BSN, RN]

Sounds fishy to me. Let's take an AK-47 to a knife fight! I'm wondering where the administrator got the rx for fentanyl. Atlanta, keep us informed.

[caliotter3]

Maybe this administrator just likes the power trip she is obviously on.

[AtlantaRN, RN]

script came from local hospital ER on pts last er visit.

nope-not filling that script, ever....

administrator was nice to me when i visited on sunday, told her of my concerns. Asked her to take any problems to my administrator on monday....I left the office at 1030 this morning and my administrator hadn't gotten a call yet.

Thanks again for all comments-sometimes i just need another to say "no freakn way..."

[AtlantaRN, RN]

Today I got a call from one of the field nurses, administrator instructed staff to "give to the hospice nurse the tramadol and lortab." Wanting the hospice nurse to destroy the meds because administrator says "we aren't giving these to the patient." Field nurse educated and showed, in the failicities hospice folder, the orders for these medications. Field nurse asked the staff to take it up with the case manager and the family of the patient. The regular case manager is calling the family member about this. This woman has 6 decubitus, 2 are stage 4----and she SHOULDN'T have pain medications???? This is utter cruelty on the part of the administrator of the facility.