Help!!

[Darknights]

Help!!!!!

I recently had a pt admitted with an large fungating SCC of the face. When he was handed over to us via the community pall care CNC we were told that the pt would die within two days. This would be either to his palate collapsing and occluding his airway, or to drowning in his own blood. She handed us a med chart with an order for a huge dose of parenteral morphine and gave us the instruction to administer that and the dose of midazolam immediately that happened to him. The dose of morphine was greater than 50mg. The pt had never taken narcotics, hadn't even had acetaminophen. We were uncomfortable with this Stat order. As she made it clear the intent of giving the dose was to immediately end the patient's life it made us even more uncomfortable.

We are used to caring for terminal patients. We average two deaths a week. We have no problem administering meds when required to alleviate suffering, when the orders are legal. All the research we did indicated this was an illegal order. We asked the physician if he could change the order to smaller doses, administered at frequent intervals for the alleviation of suffering. Even an order for sedation. He refused.

Our NUM said she'd have no trouble giving the dose and would do it herself. The juniors on our staff, aware of legal and ethical obligations, were fearful about losing their registration if they were coerced into being a witness to the administration of the dose.

I asked our pharmacist for help and he consulted many specialists who all said it was an illegal order and amounted to euthanasia. He discussed it with the physician and the response was for the order to be rewritten and underlined.

I believed I had an ethical and legal obligation to act so documented all of this in the patient's notes.

I was called to see the DON. She said she had no problem with the orders and if she lost her registration for administering the dose, so be it. She told me she was giving me the first warning for documenting inappropriately in the patient's notes about 'political issues.' If I do it again I will be terminated. She said the concerns about the dose had nothing to do with the patient's care.

Please...........can I have some feedback about this?

[netglow, ASN, RN]

Yeah, you and me.

I immediately couldn't breathe, I saw the nurse move away from me about 10 feet and go sitdown with her back to me. Tears were running down my face as I couldn't so much as blink, I tried to move my legs and arms to get someone's attention, but I was paralyzed. Oh, well I remember thinking when the alarms go off they will turn around. And that's all I remember.

When I requested records from that surgeon to bring to a better surgeon years later, pages of notes were whited out that were in sequence with recovery, hmmmm. I wonder why. This was all years before I became a nurse.

[Darknights]

Well I was a nurse when I had the scope done. But I'd had no experience with such procedures so I assumed what I'd been through was the norm, that it would be far worse if I hadn't had the midaz.

This would probably reflect the experience of the public too. They'd just think it was normal.

[netglow, ASN, RN]

We truely KNOW. I think the good part out of it is just that. We've been there and can more closely monitor with this knowledge.

Have a peaceful night!

[canesdukegirl, BSN, RN]

Clear-I had the same experience. It was downright frightful.