I have a problem that I neded your opinions on-First, let me say that what I'm about to describe DID NOT happen to me, or in the hospital where I work. I was talking to another nurse who works FT in a nearby hospital, and occasionally with us. At her FT job, she is a Charge Nurse of a med/surg floor days.Last week her floor got a patient who was a DNR.This patient was an elderly lady who's family agreed to comfort care. She was placed on a morphine drip and trans. out of the ICU, to the floor to let nature happen. The pharmacy sent the 50ml bag of NS with 50 ml morphine for a 1ml/hr drip around 1230. The patient got to the MS floor around 1430ish. The patient's family was there. The granddaughter was there, along with her MD boyfriend. I do not know who this MD is (the nurse wouldn't tell me his name), but apparently he is known to that hospitals' staff- I got the impression he might have been employed there at some time, but isn't now???(Loss of privelages??) So- Grandma gets settled in, and the boyfriend/MD approaches her nurse and states "Can we get her a morphine bolus to speed things along?" She directs him to the CN, who immediatly tells him NO, and calls the supervisor to let her know what was said. The boyfriend/MD insists on speaking with the attending MD, who just happens to be inhouse at the time. Again, the boyfriend/MD asks if he can order a bolus to "Hurry things along." The attending calls the CN, asks how the patient is looking- Cn tells him resps are 8/minute and pt. doesn't appear to be in any pain. Attending Doc says OK, keep everything the same, NO BOLUS ordered.The family and Boyfriend are made aware. Approx. 1/2 hr later, the call light goes on- BF says "She needs another IV bag, cause this one is EMPTY"- There should have been at LEAST 40 ml of NS/morphine left in the bag.Supervisor and Attending MD are called, up the hospital chain of command it goes, hospital lawyer gets called in, EVERYONE has to submit an incident report. The CN puts right in hers that she felt the bf/MD did it.Now here is where It gets even worse. The administrators/lawyer orders the pump taken out of the room.It isn't saved for the police. Either is the IV bag. The hospital tells everyone involved that they will handle it internally, and NOT to speak about it.The lady had severe liver damage to begin with, and didn't die for several hours.Am I wrong, or is the hospital trying to cover up a possible attempted murder? Aren't they bound by law to alert the police?? Isn't that "Elder abuse" if nothing else, and a state reportable incident? The pharmacy was contacted and made aware that 40 mgs of morphine is gone.Don't they have to account for controlled drugs? And what about this MD?? I really don't like the idea of someone like that being around patients.Obviously the hospital will try to cover it's own buttocks, but what about the poor nurse who had the patient. Couldn't she get in trouble because 40 mg of morphine is missing? What about the other RNs involved. Couldn't they have problems with their liscenses, ect. if it comes to light that they knew about a possible felony, but never called the police/nursing board ect.? Don't they have a legal responsibility to alert someone about this possible murdering Doc.? I was floored that she didn't seem concerned about those things. She felt that because she reported it to the hospital, she is covered. But if a patient is suspected of being abused and they are child/elderly the nurse HAS TO REPORT IT, even if it turns out not to be true, they are still mandated to report it. How is this ANY different?? What would you have done? I urged her to contact a lawyer-better to be safe than sorry.
The thing that puzzles me about this story is that if this little old lady with a bad liver received 40 mg of morphine, why did it take her so long to die ("several hours" later)? I know that much morphine would more than likely have put me into respiratory arrest within minutes.
Like I said, an RN is continuously at the bedside - 24/7. So I guess the answer is yes, someone is always there to "watch" the drip.
Remember that a drip is a med that runs continuously. Kinda like a basal rate on a PCA. There aren't any "attempts" made by the patient as there is with PCAs.
We have morphine drips too, just like you describe, on terminal patients. Except we aren't in the room the whole time. The PCA's are used on post-op patients for the most part.
Specializes in Vents, Telemetry, Home Care, Home infusion.
Let the Nurse Detectives loose:
My nursing sixth sense is saying that since the patient didn't die quickly, someone pilfered with the infusion, possibly for their own use or street sale.
I don't think morphine drips on an unsecured line are unheard of. PCAs are for people that are able to press a button (although I don't know why you can just set a continuous infusion only). In our hospital I have seen morphine drips used, but only floating to another floor. The patient was do not resucitate comfort care.
I have to ask though-- why is a DNR comfort care patient in the ICU to begin with?
I have to ask though-- why is a DNR comfort care patient in the ICU to begin with?
A lot of times when support is withdrawn the patient is in the ICU. We don't move patients out (except to a private room within the unit) when we withdraw. Half the time, they'd probably die on the way to the floor.
no way...don't buy your story at all. No hospital would allow 50cc's of morhine on a regular i.v. pump...no way....I for one as a nurse would never use a regular i.v. pole to hang a controlled medication....this story is bologna!!!
Well, unfortunatly, that's the way it is in our hospital, so I don't see it being that far of a stretch for another area hospital doing the same thing. Bad hospital policy???Heck yea, but I don't have any say in the matter. I was just upset that as nurses we get used to "Sending it up the chain of command," and figure we are covered.
Well, I think the nurse dectectives are on the case and for those of you who think the patient did not receive the morphine... You're on oops I mean onto something....LOL
I would suspect that there is a problem with the whole practice of narcs not given thru a secured line .... Just my humble opinion....
The boyfriend/MD insists on speaking with the attending MD, who just happens to be inhouse at the time. Again, the boyfriend/MD asks if he can order a bolus to "Hurry things along." The attending calls the CN, asks how the patient is looking- Cn tells him resps are 8/minute and pt. doesn't appear to be in any pain. Attending Doc says OK, keep everything the same, NO BOLUS ordered.The family and Boyfriend are made aware. Approx. 1/2 hr later, the call light goes on- BF says "She needs another IV bag, cause this one is EMPTY"- There should have been at LEAST 40 ml of NS/morphine left in the bag.Supervisor and Attending MD are called, up the hospital chain of command it goes, hospital lawyer gets called in, EVERYONE has to submit an incident report. The CN puts right in hers that she felt the bf/MD did it.Now here is where It gets even worse. The administrators/lawyer orders the pump taken out of the room.It isn't saved for the police. Either is the IV bag. The hospital tells everyone involved that they will handle it internally, and NOT to speak about it.The lady had severe liver damage to begin with, and didn't die for several hours.Am I wrong, or is the hospital trying to cover up a possible attempted murder? Aren't they bound by law to alert the police?? Isn't that "Elder abuse" if nothing else, and a state reportable incident? The pharmacy was contacted and made aware that 40 mgs of morphine is gone.Don't they have to account for controlled drugs? 
And what about this MD?? I really don't like the idea of someone like that being around patients.Obviously the hospital will try to cover it's own buttocks, but what about the poor nurse who had the patient. Couldn't she get in trouble because 40 mg of morphine is missing? What about the other RNs involved. Couldn't they have problems with their liscenses, ect. if it comes to light that they knew about a possible felony, but never called the police/nursing board ect.? Don't they have a legal responsibility to alert someone about this possible murdering Doc.? I was floored that she didn't seem concerned about those things. She felt that because she reported it to the hospital, she is covered. But if a patient is suspected of being abused and they are child/elderly the nurse HAS TO REPORT IT, even if it turns out not to be true, they are still mandated to report it. How is this ANY different?? What would you have done? I urged her to contact a lawyer-better to be safe than sorry.
begalli
1,277 Posts
The thing that puzzles me about this story is that if this little old lady with a bad liver received 40 mg of morphine, why did it take her so long to die ("several hours" later)? I know that much morphine would more than likely have put me into respiratory arrest within minutes.
I think there's much much more to this story.