How can this much Demerol be safe????

[tiredofseekers]

I work in a rural hospital in the South on a med/surg floor. We have a hospitalist who oversees the majority of our patients. Let me go ahead and say--I know that pain is what the patient says it is--and I have never refused to administer requested pain meds, except in extreme cases of decreased b/p, respirations or oversedation. I have read numerous threads stating that some hospitals don't use demerol because of its neurotoxic effects. However, we have about 8 - 10 patients that are admitted at least monthly. Their diagnosis ranges from the sickle cell crisis patients that have NO sickled cells on their lab smears, to the popular abdominal painers who inevitably will have near perfect labs and negative xrays and CT scans. They all complain of nausea, requesting phenergan every 4 hours while in between they are scarfing down pizzas and ice cream. Even the pancreatitis patients always have diet as tolerated orders. They are always allergic to Torodol, Ultram, and Morphine, or they just plain refuse the morphine. They all usually have the following orders of Demerol 100mg IV q 2 hours, Phenergan 25 IV q 4, a little Ativan here, some Benadryl there, and a couple of them are on MS Contin 60 BID. Hell, I remember one of the guys got Demerol 100mg IV q HOUR until the DON made the MD change the order!! The particular MD that orders all this medication does not care about "nursing judgement". Just let one of them tell the MD that you did not give what was requested, 80/42 bp, and you will get told to "give what I ordered when pt. asks". We even had a nurse that got written up for telling a known drug user who had a PCA as well as 2 unused ports on her Central Line that she could not go downstairs to smoke!! I am tired of running Demerol to patients every 2 hours while my other patients need attention. This is not a once in a while thing, it is every shift and you better hope you don't end up with two of them. Demerol is neurotoxic at doses above 600mg in 24 hours. We give that in a 12 hour shift!! My coworkers do not feel comfortable with this but we also need our job!! I think that the "powers that be" are afraid that if this MD is not allowed to admit such patients that he will leave and the hospital will close. I would really like to know what other nurses think of this, as we feel backed into a corner. I am sick and tired of feeling like this about my job. I love caring for people and I am usually very sympathetic to anybody who is in pain, but when there is no objective criteria (labs, xrays) to back up diagnosis, and these patients are basically allowed to determine their own discharge date (especially since they caught on to the fact that the doc won't send them home if they have not had a BM), compassion eludes me. Of course 1200 mg of Demerol per day would stop anybody up. I did sign on for this!!!! Your thoughts would be appreciated.

[classicdame, MSN, EdD]

regardless of the order, you never medicate if you feel the dose is not safe. Your license is worth more than your job. If you feel he is just playing in to the patient's need for drugs, but the dose is safe or could be construed as such, then you have a difference of opinion but probably not much else. If you have an ethics committee consider writing up the MD, or contact the Medical Society in your state. Do you have a whistleblower law for nurses in your state?

[BluegrassRN]

We cannot even give demerol IV at our hospital anymore. Too many potentially adverse side effects.

[Munch]

How are these patients being admitted to the hospital in the first place? Especially the abdominal pain patients? Why does the ED physician admit them to the floor? I've had a couple of bouts of colitis which cause abdominal pain and I've spent hours in the ED getting a CT scan which confirmed the colitis, but I've never been admitted(and colitis HURTS not to mention it causes the runs). I usually get a couple of bags of IV antibiotics(cipro and flagyl), A bag of fluids and IV Dilaudid and then I am discharged from the ED(of course I've spent hours in the ED but, was never admitted at all). Also I once went to the ER with excruciating abdominal pain, they did a CT scan and nothing came up(a few months later I was diagnosed with an ulcer) once again I was given some IV fluids and IV morphine, and was discharged home(Still in A LOT of pain). I was never admitted even though I was still having pain and the CT came back clean.

I guess every hospital is different, I just find it really odd that these patients are being admitted to the hospital with no clinical findings.

[Guest296136]

We get all the sickle cell patients on my unit, and we have two that come in just for the pain meds on a regular basis. We don't use demoral anymore, we use Diluadid and many times it is Q2 or Q1. What does your pharmacy say about the dosage? Do you have a union? How about your Quality department, they are usually the ones to make changes and address concerns at my hospital. If you are not comfortable giving any medication, I would refuse let your charge nurse or supervisor know and if you want have them give it, and see how quickly they question the orders.

[BunnySan27]

I can totally relate. I worked at an Ltac hospital, and had a couple patients that came every month or so. Both paraplegics with huge decubitus ulcers and would hound the nurses and doctors so that he could get a Picc placed so he could get his IV dilaudid and phnergan cocktail every 4 hours and convinced the doc to write an order to give both drugs undiluted iv push through the Picc and then have the nerve to tell the nurses "push it slow"........I found this to be truly disgusting especially when you have 5 other really heavy patients. I don't know why some docs feel this is okay.....blows my mind.

[LouisVRN, RN]

We have one doctor that continues to write for IM/PO Demerol as his med of choice. He has been talked to and his orders have not changed. We recently had a pain conference and were told that it should be reported to risk management every time we receive an order for Demerol.