Hospice morphine overdose

[Robbie8121]

Why does it seem there isn't a law protecting patients from

hospice overdosing them on morphine

[Katillac, RN]

The same laws and regulations protect all patients, hospice and non-hospice, from being overdosed on morphine by health care providers.

Robbie, you just joined today and this is your first post. That plus your post itself make me think you have some specific concerns about morphine use in end of life cases. You may get better results if you state those concerns instead of asking an inflammatory question that has no basis in fact.

[Nurse SMS, MSN, RN]

There are.

[hppygr8ful, ASN, RN, EMT-I]

I think the OP may be coming from a recent experience either with Family or on the job that made him/her uncomfortable. I had a lot of misgivings about hospice when my dad was dying of cancer and I really had to educate myself on the goals of hospice VS Med surge/acute care with regard to the use of morphine. My father did not start with morphine until two weeks before his death and to be honest he was is such pain at that time that even if the morphine hastened his death I saw it as a blessing.

Recently when my family had to make the decision to put my mother on hospice a relative was very against it stating "They are going to kill her with morphine!" She was hospice care for 29 days and never received a single dose of morphine but still passed peacefully in her sleep.

For many patient's dying is an active and terrifying process. One only has to look into the eyes of someone actively dying to experience the terror some feel. I am for what ever helps the patient relax and spend those last moments with family. There are protections in place to prevent a "Euthanasia" episode but the OP should remember that the patient is in fact dying and the job of hospice is to make that process as comfortable as possible. If the patient is conscious enough to ask for the morphine we give it. If not conscious or aware but struggling we medicate per protocol.

As nurses we want to help patients recover and live good healthy lives - but sometimes we have to help them in their final journey. Virginia Henderson in her definition of nursing stated:

The unique function of the nurse is to assist the individual, sick or well, in performance of those activities contributing to health or its recovery (or peaceful death) that he/she would perform unaided if he/she had the necessary strength, will or knowledge

Hppy

[neuron]

Is there proof of the overdose? Did the patient have pinpoint pupils? I would suspect overdose if this was not in an advance directive, or they were given a dose not prescribed by the MD. If an nurse gave the medication, I would look at the narcotic count sheet vs. the medication bottle which is calibrated. Then I would speculate overdose or wrong doing if these findings are inaccurate.

[cardiacfreak, ADN]

I think the OP may be coming from a recent experience either with Family or on the job that made him/her uncomfortable. I had a lot of misgivings about hospice when my dad was dying of cancer and I really had to educate myself on the goals of hospice VS Med surge/acute care with regard to the use of morphine. My father did not start with morphine until two weeks before his death and to be honest he was is such pain at that time that even if the morphine hastened his death I saw it as a blessing.

Recently when my family had to make the decision to put my mother on hospice a relative was very against it stating "They are going to kill her with morphine!" She was hospice care for 29 days and never received a single dose of morphine but still passed peacefully in her sleep.

For many patient's dying is an active and terrifying process. One only has to look into the eyes of someone actively dying to experience the terror some feel. I am for what ever helps the patient relax and spend those last moments with family. There are protections in place to prevent a "Euthanasia" episode but the OP should remember that the patient is in fact dying and the job of hospice is to make that process as comfortable as possible. If the patient is conscious enough to ask for the morphine we give it. If not conscious or aware but struggling we medicate per protocol.

As nurses we want to help patients recover and live good healthy lives - but sometimes we have to help them in their final journey. Virginia Henderson in her definition of nursing stated:

The unique function of the nurse is to assist the individual, sick or well, in performance of those activities contributing to health or its recovery (or peaceful death) that he/she would perform unaided if he/she had the necessary strength, will or knowledge

Hppy

Thank you for this Hppy. As a hospice nurse I deal with misconceptions of my speciality all too often.

When I changed positions from acute care to hospice, a lot of my colleagues and family were very surprised. I am often defending my new role by educating that everyone deserves to die with dignity and without pain and discomfort. Hospice does not kill people, we make them as comfortable as possible. Have you watched someone die in pain or gasping for air?

If a person has never received morphine, the initial doses given are low. They are gradually increased to relieve the person's level of pain or shortness of breath, and ONLY as needed to maintain comfort. Pain is easier to prevent than to relieve, and severe pain is hard to manage. Wherever possible, hospice starts treatment with small amounts of non-narcotic, over-the-counter drugs, like acetaminophen or Ibuprofen. If that works, fine. If not, the hospice team will go up the pain relief ladder until they get the desired relief as defined by the patient and caregiver. As a disease progresses, sometimes pain will spike necessitating an adjustment in medications. Pain assessments are done post administration to determine effectiveness of dose.

[Robbie8121]

Ok first off did not mean to offend anyone. I was just simply stating that it seems more often than not patients in hospice care are either ignored for what they wish or are over dosed and if what I was saying isn't true please explain the multi million dollar law suits that are being won all over the USA thank you

[meanmaryjean, DNP, RN]

Ok first off did not mean to offend anyone. I was just simply stating that it seems more often than not patients in hospice care are either ignored for what they wish or are over dosed and if what I was saying isn't true please explain the multi million dollar law suits that are being won all over the USA thank you

Why don't you provide some documentation of these alleged multi-million dollar lawsuits regarding morphine and hospice patients?

[chare]

Perhaps if you were to post links to the "multi million dollar law suits that are being won all over the USA," presumably in reference to hospice patients that "are either ignored for what they wish or are over dosed," we would better be able to discuss what happened. If, as others have suggested, you have specific questions, you might get a more detailed response if you ask them.

Best wishes.

[Alex Egan, LPN, EMT-B]

Robbie as you can see people here are more than willing to discuss the topic. However you're getting paragraphs of information but giving only sentences. I think if you take the time to compose a proper post regarding your exact concerns, maybe some examples, and especially citations of your going to use something as nebulous as lawsuits you would have a more productive discussion that answers your questions.

Good luck friend.

[hppygr8ful, ASN, RN, EMT-I]

So I just couldn't help myself. Since the OP provided no resources to back up seemingly baseless claims I went hunting. I found two stories where lawsuits were pending related to suspected morphine overdose. Here's one:

Miss. Supreme Court to hear hospice overdose case | | meridianstar.com

In a quote from the story tells us the following ;

‘‘Certainly a case like this garners sensational headlines, but it's not the norm,'' said Todd Sitzman, past president of the American Academy of Pain Medicine and the director of advanced pain therapy at Forrest General Cancer Center in Hattiesburg.

People can file a lawsuit for anything - winning it is another thing.

Hppy

[cardiacfreak, ADN]

Ok first off did not mean to offend anyone. I was just simply stating that it seems more often than not patients in hospice care are either ignored for what they wish or are over dosed and if what I was saying isn't true please explain the multi million dollar law suits that are being won all over the USA thank you[/quote

Do you have any hospice experience?

I'm starting to think Robbie might be a troll.