Lack of acute pain management for minimally conscious

[planetstef]

I need some feedback. I don't know if my pt is diagnosed as vegetative or minimally conscious officially. Pt definitely responds to pain during skin care and dsg changes. [i just removed some info because I freaked out that even the vague, general info I was giving was violating HIPAA. Sigh.]

I feel as though I am literally torturing this patient throughout multiple skin care (diarrhea) and dsg changes throughout the shift.

Please help me think this through. I am sad and also mad enough to get myself in trouble, lol. And yes, I am documenting every reaction observed, when pain medication is administered and q1h post-assessment of pain and just the facts, not being snarky. I am night shift with only one brief encounter with family early on. This is bothering me on my day off!!! Thank you in advance for your response.

[loriangel14, RN]

What are they receiving for pain and how often? Have you approached the MD? Are you medicating before moving the patient?

[planetstef]

Acetaminophen 500 mg q4h PRN and yes, I give it round the clock. And that's it. Even post-debridement surgery.

*per peg -- and a very slow-emptier

Yes, primary and residents have been asked. Residents won't go against primary's lack of ordering even after witnessing dsg change and pt's response.

Pt is q2h side to side turn.

[loriangel14, RN]

Do you have an ethics committee? That is very distressing.The poor patient.What is their reasoning for not ordering proper pain meds? Is the family aware?

[planetstef]

Doc is not informing us of reasoning officially, but rumor is doc doesn't want sedation to mask any positive changes in state of consciousness. Family apparently stated to day nursing they want pt given minimal pain medication so perhaps they are on board with this. I am nights RN. I have spent my own hours doing some research and found a few hospitals that list pain relief in their Patient's Bill of Rights. Also, some studies state that evidence shows the minimally conscious "suffer" in the same neurological way that controls do. Yes, it is distressing.

[CrunchRN, ADN, RN]

Please fight for this patient like you are doing. That is just inhumane. Does the hospital; have an ethics board you can report this to?

[planetstef]

I believe they do and I will find out. I really needed some objective validation for what I perceive as inhumane treatment.

---

They do and an anonymous reporting telephone number for unethical conduct. Huh.

[planetstef]

Okay - I need some feedback on this anonymous telephone reporting. The person taking my call is NOT with the hospital, but he states that the information I would give to him would be confidential and property of the hospital. Maybe I'm nuts but I had to tell him I needed to find out if giving him the patient-specific information to make the complaint violates HIPAA!!!! Arrrgh. Any ideas, ya'll?

[loriangel14, RN]

I would give them the information needed. You need to help this patient. Of course the minimally conscious suffer. We have a professional practice supervisor and she had told us that to not treat a patient in pain is professionally unethical.

[tokebi]

Or is there a dedicated pain management team at your hospital? If there is, would the primary at least be willing to have a consult?

[Esme12, ASN, BSN, RN]

If the patient localizes and withdrawals from pain there is consciousness there......whether or not they are "locked in" or in a persistent vegetative state is of not value as they are having pain that should be treated.

I would go to risk management/ethics/manager/chief of the department of surgery and/or your department for this lack of treatment of this patient....... for if there really is a "valid" reason there are no pain meds being given the staff needs to know so you can in all good conscience comply with the plan of care.

[Enthused RN, BSN, RN]

Interesting post. Please keep us updated OP, if you can.