I'm supposed to what now?

[jojo489]

Long story short, it was suggested to me that I administer sublingual morphine to a sleeping patient. I see several problems with this.

1. In my view, this takes away the patients right to know what medication they're receiving and also their right to refuse.

2. All I can see is aspiration pneumonia on the horizon.

3. Is that even flipping ethical?

I will not do this. Absolutely not. Not when the patient is alert and with it enough to ask what medications they are taking. My morals don't allow this.

So, what route do I take if I catch flack from management? And I'd love to hear your thoughts on this.

[jojo489]

Thank you. :)

I still cannot see (and don't agree with) administering morphine to this particular resident while she is asleep. She is alert, with it, and has refused medication for me before. I always want her to have that choice.

Now, it would be different if she were actively in the dying process, or if she was unresponsive. In that case, I would (and have) administer the morphine if she were showing signs of dyspnea or pain.

[merrywhiterose]

We give SL Ativan & Morphine Sulfate to those dying all the time. They are usually to the point that they cannot swallow medications. I've never had one aspirate yet.

[LockportRN]

Good point CapeCod, and one would hope that it was care planned as well. Also, is there a dx for the morphine? If it is for resp distress/anxiety, then it should be written as such. For this reason, I would not hesitate. Have seen my share of patients is acute distress on the mornings when these meds were not given. Not a pretty site at all. Once they go into the anxiety of oxygen hunger, it takes so long to calm them down enough to breath.

[jojo489]

It was for respiratory distress/anxiety and it was PRN until the day she passed, it never made it to routine. She also had a 1:1 aide with her overnight (my whole shift) who would watch her and let me know if she started to increase in respirations or if her anxiety increased.

Her resps were tachy and her anxiety increased when she was awake, so the morphine was necessary on days and evening shift but on nights when she slept, she was calm. I think the dim and quiet helped a lot.

And I had caught her when she was awake at one point, and she had said she didn't want it. She told me to ask before giving it to her. When I felt she needed it, she never refused it.

She never made it to the point where she was unresponsive or unable to swallow while I was present. She did get there for about 4 hours right before she passed.

What really threw me was that she was my first patient on liquid morphine that refused to take it, more than once, and she wasn't unresponsive. She was alert and oriented. I didn't feel like, in her case, slipping it to her while she was sleeping was right.

I learned from that to just go with my instincts and document. I would never deprive anyone of a med they need. My instincts are usually pretty right on.