Just my hospital??

Antikigirl, ASN, RN · Apr 18, 2007

Wow, not really being proactive on the old pain management are they!

I think that is horrible, and abusive in my book! What if a pt is taking two (or even more) at home every 4 hours...that one isn't going to cut it at all! Not to mention the added time of a pain assessment every half hour just to give that other needed pill! I personally would be raising a bit of a fuss!

The only thing I can see is if the MD's realize this, and start writing exact prescriptions for their patients. Two tabs per 4 hours either on a routine basis or prn dependnant on their patient! Or perhaps the use of PCA's would be a good idea so a patient can have contolled pain management with their button or a good basal rate or both.

I am a big pain management advocate, if my patients are in pain their stress levels and anxiety skyrocket leading to more probelms! Higher glucose levels in diabetics, lower parastalsis, immune sytem can't function well, education or communication suffers..and worse..trust is lost!

I work with a lot of people that have a multitude of chronic and acute pain issues...and when I hear of staff accusing them of being drug seekers I bring up the simple fact...."there are much easier ways of getting drugs than staying in a hospital with heck knows what tubes and wires on ya!".

deanaRN · Apr 18, 2007

We have two orders entered on the MAR. Ex. 1 Percocet q4, and another 2 q4 -

princess_picklejuice · Apr 18, 2007

Our hospital has eliminated all range orders, dosage or frequency.

Not only that, it applies to meds like Tylenol. No longer can a doc write "Tylenol 1-2 tabs po q4h prn"

Now, there also has to be an indicator such as "Tylenol 1 tab po q4h prn headache" or "Tylenol 2 tabs po prn temp >101 degrees."

This is a JCAHO thing. Apparently JCAHO refuses to acknowledge that nurses have the ability to think critically.

angel's RN · Apr 18, 2007

What we do now is, after we rate the pain "on a scale of 1-10" (where have we all heard that 1,000,000 times? :uhoh3: ? ), if the patient rates the pain 5 & below, we give 1 tab, then if the pain is not better in 1 hour, give the other. If the pain is 6 & above, we give 2 tabs. How confusing is this? :banghead:

As if we didn't have ENOUGH to do--------------

's RN

DutchgirlRN, ASN, RN · Apr 18, 2007

Just the other day, a new policy became official in my hospital. We can no longer give meds on a range schedule. Like 1-2 Percocet Q4 hrs. Now we have to give 1 and then if the pt. needs it we can give another in a half hour. We all think this is ridiculous and is only going to cause our pts more harm as they get behind on their pain management. Are any other hospitals doing this? I'm not sure who made this decision. :angryfire

What happened to doctors orders? Do the doctors go along with this new policy? We're they even consulted?

If the doctors order says 1-2 tablets and you give two at the same time then you are practicing responsibly and there's really nothing legally the hospital can do if the patient requests 2 tabs. We all know many patients do require 2 tabs for pain relief and the hospital has no business making such a judgement. That's left to the doctors.

Where I used to work we also had two seperate orders when an order like that was written and we could give the second tab within 30 minutes. We were on E-mar (scanning) so you couldn't give the 1 tab ordered if the 2 had already been given.

I'd ask the doctors what they know about this policy.

loricatus · Apr 18, 2007

No range orders either at the hospital I am at. Prn meds have to be clearly defined: eg, pain: 1 percocet tab po prn mild pain w/ location of the pain stated q 4 h, 2 percocet tabs po prn q 4 h moderate pain (again the location of pain), morphine 5 mg IVP prn q 4 h severe pain... The nurse must document the pain scale on the notes and is allowed to make the judgement, based on the pain scale score if it is mild (usually 1-3/10), moderate (4-6/10) or severe (7+ out of 10). This does allow for some 'creativity' in pain management, as long as it is explained to the patient on how they can rate the pain at the particular time.

nurseklw72 · Apr 18, 2007

Our facility went to the no range rule about a year ago thanks to JCAHO. Our orders read ex: vicodin 5/500 1 tab for pain rated 1-4 on # scale. 2 tabs for pain rated 5-10 on # scale.

morte, LPN, LVN · Apr 18, 2007

Not only that, it applies to meds like Tylenol. No longer can a doc write "Tylenol 1-2 tabs po q4h prn"
Now, there also has to be an indicator such as "Tylenol 1 tab po q4h prn headache" or "Tylenol 2 tabs po prn temp >101 degrees."
This is a JCAHO thing. Apparently JCAHO refuses to acknowledge that nurses have the ability to think critically.

that tylenol order was never correct....there needs to be a reason to give....and the 1 or 2 has been graded to pain levels in long term care for sometime....but this particular hosp ( in the op) is going out on a limb in a different direction....and half an hour really isnt long enough to get an idea of efficacy.....i wonder if this is a last ditch effort to get docs to conform?

Rnandsoccermom · Apr 18, 2007

It's not just for JCAHO, it's so the pharmacy can properly CHARGE the patient. We have started this and apparently every pill must now be charged for individually. Our pharmacy services are outsourced. Big business in the hospital setting.

Pepper The Cat, BSN, RN · Apr 18, 2007

I hate pain scales. (I know, I'm a rebel). I hate asking someone to "rate" their pain. Each person's pain in individual. One persons perception of a "4" maybe someone elses perception of a "6". If you ask me to rate my pain, I can't. It hurts. Period.

As for the tylenol order - if tylenol is ordered for pain, and the pt has a temp, are you telling me that I can't give the tylenol? Fine - I'll kick the pts in the shins, he'll have pain and I can give it! (Kidding!)

crissrn27, RN · Apr 18, 2007

We don't have range orders anymore,either. JCAHO thing. Thank goodness I work in the well newborn nursery and don't have to worry about it