Just my hospital??

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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

Specializes in Home Health Case Mgr.

Yep...it is ashame that someone would begrudge a nurse out of what little decision making autonomy they do have! I guess we are to be robots and not think or plan or even rationalize. If the docs had their way, all nurses would be fired and all replaced with unlicensed, cheaper labor.

:o

ERDude

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Specializes in ICU/ER/TRANSPORT.

Well folks that is what you get when a few "Bean Counters" get out from behind that fat desk of theirs and start writing policies as if they know whats going on in the nursing world..And heck why should we try to use any type of judgement, hey just ask JCAHO..

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Specializes in Med/Surg; Psych; Tele.
Well folks that is what you get when a few "Bean Counters" get out from behind that fat desk of theirs and start writing policies as if they know whats going on in the nursing world..And heck why should we try to use any type of judgement, hey just ask JCAHO..

Hey man...JCAHO knows best! I mean, they are so good, that they can most effectively deal with the personal pain issues of patients' without even seeing them! What do we know?...we only interact with them several times a day, read their histories, etc.

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We still do pain ranges - and when a pt gets only 1 percocet, they're only charged for 1 percocet. The pts are billed according to what is taken out of the pyxis. I don't understand how getting rid of ranges helps with pt bills?

And, a pt's pain should be dealt with on an individual basis. Like what the other poster said, a 3 to one person is an 8 to someone else. In addition, pt's change their pain scales on a daily basis. Some get confused and don't even understand the pain scale.

What is this accomplishing? More work for the docs to write detailed orders, more work for the nurse to document, and more limitations for pts to get treated for pain. Not to mention that the nurse will have to chase down docs for new orders even more often - just another way to limit a nurse's ability to actually spend time with the pt. I hope this new concept doesn't come to my hospital for while. This doesn't seem to be helping anyone - did they even think this through?

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Specializes in ICU;CCU;Telemetry;L&D;Hospice;ER/Trauma;.

Money and JCAHO....

Money and JCAHO....

Go together like

David Koresh and WACO....

oh...help me....

Just once, I would love it if I could get one of these brick-brained dunderheads as a patient with severe unrelenting kidney stone pain....or shooting back pain.....or deep throbbing migraine pain.....

ME: "I'm sorry, sir/maam, I can only give you ONE small pain pill because that is the hospital policy now, because I no longer have a brain and cannot think, see, smell, feel, or hear for myself."

THEM: "pleeeease! my head, heart, back, bones, et al are killing me!!"

ME: "well, you have to wait an hour...I will be back after I finish filling out the six useless forms our hospital says we now have to fill out in order to meet your organization's requirements....please, try to stay calm and enjoy your stay here at blah blah hospital/medical center."

I think these people aren't people....they are evil aliens sent to destroy our sanity.

ugh.

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Specializes in Staff nurse.

I work nights and usually give 2 in the 1-2 range to aid in sleeping better, ie. not waking up in pain as soon.

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Specializes in NICU, PICU, educator.

no more range orders here...gotta love JCAHO.

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Specializes in Telemetry, Oncology, Progressive Care.

We still have range orders. I hope my hospital doesn't get rid of them. Yes, we can think critically. JCAHO is a big PIA! You can't lump everyone into the same category. Everyone is unique.

As far as pain meds go everyone reacts differently to them and what kind of pain they are having. A little old lady may do fine with 1 Tylenol and a larger person won't. Personally, when I am giving pain meds I ask the person what they have done in the past or what they generally do at home. I also let that guide me in how I manage their pain.

Yesterday I had an order for 1-2 mg of Ativan because she gets really restless and probably won't be around much longer because she suffered an MI and massive stroke. I hated to see her suffering and knew the previous nurse had been giving 2 mg of Ativan so why would I just want to do 1 mg when I knew she needed 2 mg. Anyways if you are always having to give the smaller amount of range orders I would be wasting a lot of narcotics because we can't get Morphine or Ativan in 1 mg. The smallest vials we have are 2 mg so how are the hospitals saving money with that? I'm sure the patient isn't getting charged for 2 mg if you only give them 1 mg. The hospital is eating that cost, right?

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Specializes in ICU;CCU;Telemetry;L&D;Hospice;ER/Trauma;.

Kellykul, the patient is ALWAYS charged for whatever the standard dispensing mg. size is....the hospital will never 'eat' the cost of anything....

they don't care about what you don't give....they only care about what was charged out to the patient...and medicare...ahem.

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Specializes in Tele, ICU, ER.

Our hospital still allows ranges like "Percocet 5/325 1-2 tabs po Q4hours prn pain".

That said, we're on the JACHO kick too, so I'm sure it'll change. Of course, where I work, the communication between staff and tptb is so horrible that it'll be months before we find out about new requirements (and then, ONLY becuase some new form will appear nearby) and it'll be only weeks before we're yelled at for not following some new rule we were never told about. Same old, same old.

I'ts enough to make me bang my head against the cement wall each and every shift - think I can get workman's comp for that?

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Specializes in Obstetrics.
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.

Good point you have there. I am sure it is disguised as a patient safety issue, but clearly these types of orders allow a nurse to use her/his assessment skills to decide which dose would be appropriate for the patient; the new method takes that ability away.

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The issues we used to have regarding analgesics orders and ranges had to do with the time ranges. For example: oxycodone 5-10 mg q 2-4 hours. What was happening was 10mg would often be given every 2 hours.

Analgesics can still be ordered without a time range. For example: oxycodone 5-10mg q 4 hours. Basically I talk to the patient to clarify what their need is. Some have tried the higher dose first and felt it was too much, others are unsure whether or not they want the higher dose. If they decide they would rather start with a lower dose first, they still have the option of receiving the second pill/dose if necessary.

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