I recently had a patient on my unit that had fractures to BLE. She had been high when she wrecked. This patient had surgery, then went to a physical rehab center. She was back again to have her external fixator removed.
She was her for SIX weeks.
When I had her, she had:
A dilaudid PCA with the maximum dose for her height and weight
Two Percocet 10 mg ordered q 4 hours for "breakthrough" pain
1 mg Ativan IVP q 6 hours
25 mg Benadryl IVP q 6 hours
She requested her percocet everytime she could crack one eye open. She wanted the benadryl and ativan given at the same time.
One night, while I was taking care of her, she was extremely sedated. She would call out for percocet, but when you went in the room she was asleep and wouldn't rouse to verbal stimulation. When she did wake, she stuck out her tongue and mumbled "Juth put them on mah tongue" even though there were no injury to her upper extremities. She was too sedated to hold a cup of water. Other nurses had poured the water into her mouth. I refused. I told her that I would not give her the pills unless she could put them in her mouth and swallow water. She still had her PCA and it wasn't maxed out. Later, when she was more alert, I did give her the percocet.
She reported me the next day.
My manager wrote me up and said: "If they can ask for it, they aren't too sedated."
I had been taught in nursing school that we are to use our judgement. A physician's order will not save our license. If we give a patient narcotics when we see they are too sedated and a sentinel event occurse, we are liable.
What do you think about my manager's statement? I was written up for "withholding pain medicine". I refused to sign it because she had a PCA. Since it wasn't maxed out, she still had access to pain medicine.
