At my new job... a few of the nurse managers have been telling us who work the floor that if we administer a PRN for pain that doesn't have a pain scale given as a parameter, that our licenses are in jeopardy.
Say, if there's an order for morphine 1mg, ivp, q6h, prn, for pain... without a specific pain parameter say like "5-10" or what ever the doctor wants it to be ...
that we shouldn't be giving the medication until we get a specific pain scale range to use.
Although I have limited experience working at another hospital and a snf, I have never been told this before and was wondering if this is normal?
Also, say if a doctor orders a foley.... and doesn't write in their notes specifically WHY...we nurses are supposed to call the docs and get a specification as to why.
I was just going to mention this. I work at a large University Medical Center and we have recently been discussing this same topic. We will still ask their pain level but are doing away with dose ranges completely.
Sigh. Wish you were kidding about this. Again, sounds to me like reimbursement issues that someone was dinged on, so they are making stuff up....
Is your supervisor a nurse? A nurse who has practiced recently? Or even one that realizes that most nurses practice read back order taking?
If this is a surgery center, perhaps the supervisor could think about standing orders?!?!?! Chart audits right away so that specific things can be dealt with then and there instead of threats?
Again, if you do not have malpractice insurance, get it.
Standing orders would be nice. I had to sit down with one of the new docs for 3 minutes too long trying to explain that pharmacy wouldn't allow me to get morphine out of the pyxis until he entered in a pain RANGE for which it could be given. He said he didn't under stand. Kept wanting to use the > symbol. I told him, no, that's not what the pharmacy (really the hospital) wants you to do! Showed him a way to enter in the pain score range and it was ok.
Then, for other patients with PO pain meds or different pharmacists working when the orders are put into the system, no pain range is in and that's what we get threatened about. No, it's not very nice.
I have no clue how she supposedly discovered nurses aren't taking orders properly. I have only been on this floor (med-surg/ortho) for two months and have witnessed it. I don't think so but I might be guilty of it myself? It's a busy busy busy chaotic floor.
My manager is a RN, MSN. I think she said she worked bedside for 10 years, but you would never know it now. She doesn't pitch in, she usually hides in her office and leaves early. When I was getting my seven days of orientation, it was so busy out on the floor and sometimes my preceptors would be elsewhere. So, I asked her a few things about the computer charting and she didn't even know how to do it.
Interesting and informative. Although this does claim that pain level interpretations are subjective, this article kind of supports providing a pain range; am I wrong?
Does that pain scale rule account for pt's unable to rate 1-10, such as severe cognitive deficits, early developmental stages. aphasia, intubated/sedated, chemically paralyzed?
Most of my pt population is unable to rate (SICU.) We give pain meds on the assumption that the pt has pain (a fair assumption in multiple trauma pts), by nonverbal/physiological signs, and if the pt nods "yes" when asked if having pain. Just a "yes," without a rating and comprehensive subjective pain assessment--again because their ETT prevents them from speaking.
Sounds like a recipe for false documentation to me.
And what about preemptive pain medication? I mean like the advice to medicate before pain is out of control, or before PT because we know that PT exercises are painful in the early stages of recovery?
I think pretty low of that rule, if you can't tell.
Specializes in orthopedic/trauma, Informatics, diabetes.
There are other pain rating scales: Wong-Baker, FLACC, which we use for pts with AMS or dementia.
Pain is subjective, and we are taught that what the pts pain is, is what they say it is. The only contraindication would be if they are sedated and, using our nursing judgement, we feel that when a person says their pain is a 10 but can't carry on a conversation because they are sedated, we can medicate (or not medicate) as we feel safe. We also pre-medicate for PT.
I'd take that license of mine that they keep threatening and walk away. Seriously!
And just today, I opened my work email only to discover another NASTYGRAM about how if we nurses are not repeating orders back to physicians that we are supposedly "out of our scope" and "prescribing without a license" and that our nursing license is "in jeopardy" if we fail to repeat back orders. Yes, I learned in school to read back all orders. I know it's the right way.
And just today, I opened my work email only to discover another NASTYGRAM about how if we nurses are not repeating orders back to physicians that we are supposedly "out of our scope" and "prescribing without a license" and that our nursing license is "in jeopardy" if we fail to repeat back orders. Yes, I learned in school to read back all orders. I know it's the right way.
And what about preemptive pain medication? I mean like the advice to medicate before pain is out of control, or before PT because we know that PT exercises are painful in the early stages of recovery?
I think pretty low of that rule, if you can't tell.
Me too
Well, I for one give po pain meds to my patients before PT works with them. Wrong as it may be according to the management, I am writing what I have to write in regards to the darn pain rating thing so that I can utilize the prn pain medications prescribed as appropriate for each patient.
Managing post-op pain before it gets to a 6 or above by giving po pain meds like Percocet on a fairly consistent schedule keeps the pain under control better than waiting till they are a 8-10, flustered, REALLY uncomfy, and upset and having to give dilaudid (!) --- that's what my instructors in nsg school said, anyways:)
There are other pain rating scales: Wong-Baker, FLACC, which we use for pts with AMS or dementia.
Pain is subjective, and we are taught that what the pts pain is, is what they say it is. The only contraindication would be if they are sedated and, using our nursing judgement, we feel that when a person says their pain is a 10 but can't carry on a conversation because they are sedated, we can medicate (or not medicate) as we feel safe. We also pre-medicate for PT.
We can use FLACC too. And Wong-baker I think ? Not sure about that one though...
FlyingScot, RN
2,016 Posts
I was just going to mention this. I work at a large University Medical Center and we have recently been discussing this same topic. We will still ask their pain level but are doing away with dose ranges completely.