MD ordered placebo for pain PRN~would you give it?

Nurses General Nursing

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I am an RN student who will graduate in May. I ran across a situation during my clinical the other day that I wanted to seek some experienced advice on. This was my 3rd or 4th day of clinical at this hospital so I was still getting oriented to everything and trying to familiarize myself with all the "policies and procedures."

I do not have an instructor with me but my preceptor is great and always answers my questions but even she seemed to be at a loss of explanation for this one.

The secretary for the floor asked my preceptor to try and decipher an order for a new med scribbled out on the pts chart so it could be ordered. It was determined to read "Placebo for pain PRN" and scanned to the pharmacy. So of course I had to ask my preceptor if this was normally done at this hospital and what exactly would be given to the patient.

She did not seem to surprised by the order and said she had not ever had this ordered for any of her patients so she did not know what would be given. (she was acting as charge nurse so we had to view the chart)

Being new and a student and not knowing the entire situation I did not say anything else to her but I did ask another nurse what her opinion of giving a placebo for pain was. She seemed surprised that this was actually written on an order and scanned to the pharmacy but also said she had never had this ordered for any of her patients before so she really did not know what to tell me.

All I want to know is this something that goes on and nurses are doing? I would not give a placebo pain med to a patient, ordered or not. It is not honest and goes against all I have been taught in school about an RN being a patient advocate, practicing with fidelity and non-maleficence. Am I just being naive?

If the patient were to find out they had been mislead and wanted to press charges against the MD, the hospital and the nurse wouldn't that qualify as an intentional tort on my part-as my instructor always says "a prudent nurse would have known otherwise!":bugeyes:

I do not know if the order was ever carried out but I was told the doctor had discussed this with the patient's nurse. Whatever that meant? I have chosen to use this as an ethical dilemma I encountered during clinical to write a short paper on so any feedback would be appreciated, pro or con.

Thanks.

Specializes in Critical Care.
... when you patient asks you what they're getting, what do you say?

Obecalp® 4 mL IVP.

/I kid, I kid.

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Tramadol binds to mu receptors just like opiates do. It inhibits norepinephrine and serotonin reuptake so it is far from being a placebo. However, we all react differently to drugs. If it doesn't work for you then it just means you need something else for your pain.

our hospital policy is to use codeine as part of the analgeisic ladder but 10% of the the population cannot metabolize it so tramdol is the be used instead. perhaps codine would work better fore you.

oh tramdol is dilsiked due to its side effects

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oh tramdol is dilsiked due to its side effects

And perhaps, sometimes, for its lack thereof.

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Obecalp® 4 mL IVP.

/I kid, I kid.

I love it!

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Sorry, next time I'll lie so that you feel better.

Ultram is a wonderful drug! It works just like narcotics and I fully expect it to work every time I give it!! The mechanism of action is identical to morphine but you won't get addicted to it! :rolleyes:

This made me giggle, but leave out the not getting addicted part. That may be a turnoff to some people!

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I resent you saying tramadol is a throw-away drug.

no, it doesn't work for everyone. But then neither does tylenol.

I take tramadol for my chronic pain (a form of lupus, not SLE). Works pretty good, allows me to continue to work on the days the pain is bad and doesn't mess with my brain. It's my 'second-line' med, if the excederin isn't working. Hydrocodone is my third-line, when I'm off the clock. Yet it doesn't touch my headaches or neck pain... go figure.

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Specializes in MICU, ER, SICU, Home Health, Corrections.

Man, what a long and liberal thread. It never ceases to amaze me how people want to preach about "can't see someone's pain" then proceed to describe the 'pain face' that goes away when the narcs flow, and use that as their "proof"... are you serious???

One liberal's pain face is another conservative's withdrawl face.

And yes, withdrawl hurts. Bummer.

If "lying" to you fixes your problem, then I'm a liar and proud of it.

I get so tired of 10/10 pain... you know, "the worst pain you can imagine".. while kicked back reading, watching TV or worse, up in the hall throwing a fit. Seems the worst pain some can imagine is a stubbed toe.

I imagine if I'm in 10/10 pain, conversation might be impossible, let alone arguing over drugs.

My answer to the OP? "ABSOLUTELY!"

Start low and move up. Dilaudid-on-tap is not the answer to everything.

It's whatever works. If saline cures you, then you're cured. Like it or not.

Sheesh.

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Specializes in ER/EHR Trainer.

Hope I never run into you in an ER! If I go to the hospital it's because I need to be there, many people are just like me and wait until they need relief!

I entrapped a nerve last year and yes experienced burning shooting spasms that were 10/10, had trouble quantifying my pain, and got sick of the fish eye from employee health as it was workman's comp. I was sick of them and sick of pain! Eventually it resolved due to complete rest of the leg and medicating, YES I SAID MEDICATING IT!

Yet, I worked the entire time and remained a professional-albeit light duty. Pain is present whether someone is watching tv or sleeping and if you don't know that, God knows you shouldn't be treating it!

Saline doesn't cure, and Jeez unless you are the Almighty don't think you know what people live with!

Don't judge others wanting some relief and those of us willing to treat it!

Conservatives or Liberals, good medical professionals treat patient's pain and don't pretend to be psychics!

M

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Specializes in Psych.
"Re: MD ordered placebo for pain PRN~would you give it?Man, what a long and liberal thread. It never ceases to amaze me how people want to preach about "can't see someone's pain" then proceed to describe the 'pain face' that goes away when the narcs flow, and use that as their "proof"... are you serious???

One liberal's pain face is another conservative's withdrawl face.

And yes, withdrawl hurts. Bummer.

If "lying" to you fixes your problem, then I'm a liar and proud of it.

I get so tired of 10/10 pain... you know, "the worst pain you can imagine".. while kicked back reading, watching TV or worse, up in the hall throwing a fit. Seems the worst pain some can imagine is a stubbed toe.

I imagine if I'm in 10/10 pain, conversation might be impossible, let alone arguing over drugs.

My answer to the OP? "ABSOLUTELY!"

Start low and move up. Dilaudid-on-tap is not the answer to everything.

It's whatever works. If saline cures you, then you're cured. Like it or not.

Sheesh. "

I concur. Of course I worked all psych, including substance abuse/ dual dx/etc. There were more times than not people at the med window yelling for their pain med, coming up saying they have 10/10 pain after they were just seen on the unit catching a smoke, standing around with other patients, smiling and laughing and appearing to be having a grand old time. How can you be in the worst pain of your life, unbearable 10/10 pain, and be doing these things? I don't think so. I will give you what you have ordered but for those patients in particular I am not calling the doc( who we have already asked b/c you were so upset earlier)for MORE pain meds. Now don't get me wrong, there are lots of patients that are really in pain and use their pain meds appropriately. I know, I know, pain is what the patient says it is. But let's be real folks, how much are we really doing for the seekers out there?

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Specializes in ER/EHR Trainer.

I agree there are seeker, work in the ER-YOU KNOW I SEE THEM , however think about how medicine works. If the physicians, mental health professionals, alternative medicine, and proper management were available to all. The simple truth would be THERE WOULD BE NO SEEKERS, or maybe just a few unlike the scores we possibly see!

But due to our systems we make them, plain and simple. Don't like it-do something about it!

Until then, treat the pain, counsel the patient, effect change in the system and maybe someday medicine will work for those in chronic pain, and with those with chronic conditions like sickle cell.

M

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Specializes in MICU, ER, SICU, Home Health, Corrections.
Hope I never run into you in an ER! If I go to the hospital it's because I need to be there, many people are just like me and wait until they need relief!

I entrapped a nerve last year and yes experienced burning shooting spasms that were 10/10, had trouble quantifying my pain, and got sick of the fish eye from employee health as it was workman's comp. I was sick of them and sick of pain! Eventually it resolved due to complete rest of the leg and medicating, YES I SAID MEDICATING IT!

Yet, I worked the entire time and remained a professional-albeit light duty. Pain is present whether someone is watching tv or sleeping and if you don't know that, God knows you shouldn't be treating it!

Saline doesn't cure, and Jeez unless you are the Almighty don't think you know what people live with!

Don't judge others wanting some relief and those of us willing to treat it!

Conservatives or Liberals, good medical professionals treat patient's pain and don't pretend to be psychics!

M

Wow, my bad....

I didn't realize this was all about *you*.... ?????

[but thanks for a perfect example.]

Oh, and if you have a sec.... please... point out where I:

a) said I wouldn't treat anyone's pain,

b) said someone didn't need to be in the hospital,

c) passed judgement on someone,

d) said I know what people live with,

e) said pain wasn't present,

.....and I'll be happy to re-word it.

Maisy, you're last post also confounds me... it says "yes, there are seekers, but the system is broke, and it's our fault, so we should change it but until then, continue to give drugs and effect change..." What does that even mean????

And the part about a good healthcare system being seeker-free?? OMG... I'm sorry to offend, but that statement is simply absurd.

as always, peace, love and joy! LOL.

rb

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Specializes in ER/EHR Trainer.

What's hard, addicts are made not born. If it requires alot of drugs to take care of their pain, it's not their fault.

It's obvious when a statement is made "about the long and liberal thread, and the pain face being equal to the withdrawal face" we have a difference of opinion, regardless of the point of that fact sometimes being true.

Everyone seeking relief is not an addict. Everyone seeking relief may be dependent, but not an addict. Everyone seeking relief may be an addict, but need relief. Regardless of the person's status: the shared need is relief!

I am sorry you don't get it, perhaps my thoughts weren't clear enough. If time were available for our patients, if alternative medicine and biofeedback were available, if the best technology were available,IF......(FILL IN THE BLANK) were available for pain relief...available to those across the economic spectrum.....available regardless of education, or part of the country.....perhaps, drug dependency in the way we see DESPERATION in the ER would not exist. Perhaps people would actually be able to live productive lives. HOWEVER, it isn't and doctors and hospitals continue to throw the magic pills without backup, counseling or other management techniques to help their patients. They don't give people realistic expectations for lifelong pain, and the system IS BROKEN.

The only absurdity is that with the amount of providers and technology in this country is that people suffer needlessly, and that there is even a discussion about placebos or that any doctor would order the provider who is to be most trusted and the patient's advocate to violate that same patient's trust.

Anyway, we all have to do what we think is right, believe what we do is right and live with those thoughts and actions daily.

M

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