IV Fentanyl use on Med/Surg Unit

Nurses Safety

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I am wondering if anyone out there has concerns about the use of IV fentanyl on a general med/surg unit for pain. We have been debating this issue in our hospital for months. Physicians are pressuring administration to allow them to order it for any pain situations they want. Many of us Med/Surg nurses believe that the literature supports our reluctance to push IV fentanyl to patients that we may not be able to monitor closely in a 1:1 setting. The literature says IV fentanyl is used in anesthesia and sedation type settings...where patients are monitored very closely and people are trained in airway management. Our doctors are alway giving "ranges" of amount and frequency that leave a lot to nursing judgement. It is frightening to think of our junior nurses managing this medication. We are not afraid to IV push meds like MS or dilaudid as they do not "read" like fentanyl in the medication literature. Duragesic patches and Actiq are acceptable methods of delivering Fentanyl on a med/surg unit that we are happy to use.

We have been told we need to develop a "time line" to bring the IV method of delivering fentanyl to the med/surg unit. Therefore, we need to know how other institutions are handling this drug. Is it treated differently than IV morphine or dilaudid in your institution? Do nurses need ACLS or extra training? Do patients have monitors on them like oximetry?

Thank you for all the information you all gave. It is now in the hands of management and I can only hope they will do the right thing. Our nursing management does have major concerns so I believe we and our patients will be protected. I will keep you all posted. :)

All I have to say is theres always narcan!~!!!! I have given fentanyl and have had blue patients, I have given dilaudid and have had blue patients, FUN=FUN-FUNFUN!!! :uhoh3:

and then again not so fun!!

At my institution fentanyl can not be given on a medsurg, tele, or pcu unit, As long as its in the policy of the hospital or institution you work at, and its ok to give per hospital policy without a 1-1 monitor, then give it, if the patient dies your covered. I love to quote hospital policy when someone tells me to do something that I know isnt allowed the patient care manual. Really? an RN was fired, I guess there isnt a nursing shortage in your neck of the woods. I can be as stubborn as I want and no ones firing me. No one wants my job.

The idea about giving it as long as it is hospital policy probably wouldn't fly in a court of law. I think it goes something like this..."what would any PRUDENT

nurse do in a similar situation".

One thing I know for certain is that fentanyl is NOT just another narcotic. It causes problems that narcan can't fix...I'll stick to my Morphine thank you very much.

This little debate has made me more certain than ever that I personally won't give it on a med/surg unit. I'd rather be fired and have my license in my pocket than lose it because I didn't use the knowledge I have. Another thing....if the patient died it won't matter if there was a hospital policy or not....I would know that I did not do everything I could to assure the patient's safety. If I get fired I can sue the hospital or just find another job...if the patient dies, that was a human being who trusted me to deliver the safest care possible! We are patient advocates, that is an important nursing responsibility. :)

In case anyone hasn't noticed it is the hospital administration made up of doctors, nurses and various others' who agree and compose hospital policy and procedures. If you know your institutions policy and follow it, then you are covered by "respondeat superior" in a court of law.

Let me tell you what isn't prudent. The fact that nurses are forced to take care of more and more patients, who are sicker and moving quicker through the system every day. 30 years ago the ICU patients of today would have been dead. The med/surg patient today is the ICU patient of the past. TOO MANY PATIENTS =====SHODDY HOSPITAL STAFFING

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