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 ER/EHR Trainer.

Just because someone appears unconscious does not mean they can't feel pain. Ask you peers who have cancer patients. Some cancers are so insidious that unless artificial coma was induced and perhaps even then (we really don't know), pain exists, and is very real to the sufferer.

That's why morphine is used...no ceiling.

Again, we all know mind over matter. God help any of us, if we are in that spot. I want the nurse caring for me to push, push, push.

M

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Specializes in Community, OB, Nursery.

Yeah that, Maisy. I've told everybody I know that when it's obvious that it's my time, please crank up the morphine and let me go.

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Specializes in telemetry, med-surg, home health, psych.

Anyone else see the episode of MASH when they ran out of pain medication...

Had a room full of pts. and finally thought to try placebos...

50% of them got relief and enabled them to sleep....

I must agree that "mind over matter"..has some validity...in rare circumstance I can rationalize giving a placebo...

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Specializes in ER/EHR Trainer.
Yeah that, Maisy. I've told everybody I know that when it's obvious that it's my time, please crank up the morphine and let me go.

With you all the way!!! My body may die, but my soul will soar free!

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Specializes in ER/EHR Trainer.
Anyone else see the episode of MASH when they ran out of pain medication...

Had a room full of pts. and finally thought to try placebos...

50% of them got relief and enabled them to sleep....

I must agree that "mind over matter"..has some validity...in rare circumstance I can rationalize giving a placebo...

Yeah and all nurses wear low cut mini dresses with boobs spilling over the top, oh yeah all male nurses are gay, or how about all nurses are old battle axes....oh, forgot Hollywood representation of healthcare.

How much that you've ever seen on TV is true? For the exceptions =

Treat the patient. PAIN THE 5TH VITAL SIGN! Pain is what they say it is! Pain is regulated and must be managed and reassessed. Tough cookies to physicians who don't like it, and to everyone else....FYI you can be sued for inadequate pain control....so call those docs and document....be a pain, so they control your patient's pain!

M

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....FYI you can be sued for inadequate pain control....so call those docs and document....be a pain, so they control your patient's pain!M

how can an md be sued for inadequate pain control, if the pt is in such a dangerous state that s/he risks resp arrest?

i'm just not understanding why we/md's cannot tell the pt, "I CANNOT GIVE YOU ANYMORE".

why can't/don't we?

what am i missing???

leslie

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Yeah that, Maisy. I've told everybody I know that when it's obvious that it's my time, please crank up the morphine and let me go.

Ditto that. Please don't let me die in terrible pain. Crank it.

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Specializes in Psych, ER, Resp/Med, LTC, Education.

Absolutley not...this is illegal and unethical. The only place this is ever legal is in a study when patients SIGN saying they know they may get a real med or they may get placebo.......Are you kidding me??? I would be so going to the ethics committee with that one and maybe to the Medical board for your state.

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Absolutley not...this is illegal and unethical. The only place this is ever legal is in a study when patients SIGN saying they know they may get a real med or they may get placebo.......Are you kidding me??? I would be so going to the ethics committee with that one and maybe to the Medical board for your state.

Agreed. If it part of a trial where patients are giving their consent and it's on the up and up that's fine. Anything else and not only would I want no part of it but I would be reporting it.

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Specializes in ER/EHR Trainer.
how can an md be sued for inadequate pain control, if the pt is in such a dangerous state that s/he risks resp arrest?

i'm just not understanding why we/md's cannot tell the pt, "I CANNOT GIVE YOU ANYMORE".

why can't/don't we?

what am i missing???

leslie

I'll give you an example, recently had a patient who was on extended relief morphine PO, with dilaudid for breakthrough pain-came to ER in crisis. Our order-1mg dilaudid iv, I asked the doc did he even look at the meds on the triage list-yes, I can't bear that liability. Called patient's regular doctor who wrote correctly for pain. There was no respiratory distress involved, JUST PAIN!

Respiratory arrest in a going to live patient, or a patient experiencing a painful death?

What about alternative methods, nerve blocks, epidurals, patches for continued medication? Pain isn't conducive to healing, or dying. Why have it if you don't have to?

And what I meant is if pain isn't addressed or reassessed you are opening yourself up to a lawsuit. That's why people with chronic pain are asked what is comfortable for you? Perhaps there is always an ache they co-exist with....but acute pain, increasing pain, or new pain for the chronic sufferer is another story!

M

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Like I said in the original post I did not know the specifics of the patients situation or the final outcome; I just saw the written order and questioned my preceptor and other nurses about it and wanted to know if they would follow through with this order. I have heard of this being done but had never seen it actually writen out on an order and placed in the patients chart! I know I personally would not give a placebo for anything unless the patient was aware of it and agreed to give it a try. I most definetly would not mislead a patient by giving NS or whatever else to trick away the pain; even if it worked, to me it is unethical-a lie is a lie.

As a student and nurse extern I have heard many nurses complain about having to give pain medication to "frequent flyers" and others who were determined to be drug seekers. My thoughts on this are if they say they are in pain, they are in pain, if they have the medication ordered for this pain, and it is safe to give, give it. Yes it may be aggravating to get the call from so and so every 2,4, and 6 hours for the PRN pain med and they rate their pain a 10 while watching TV and eating Jello but how do I know what they feel and what determines their tolerance and pain relief. Addiction is a disease and the pain felt when it is not "fixed" is real. I have seen what goes on in surgery; having your stomach cut open, guts removed, probed through, cut in half, stapled together, stuffed back in and stomach stapled back up deserves some pain relief even 5 days post-op! Then we ask them to walk, turn, cough, deep breath 1 day post-op we know its for their own good but all they know is it HURTS like**** I do not think many nurses would argue with this but I will not be the nurse to pass judgement or the nurse to predict pain in any situation.

Thanks for all the responses and opinions. I will consider them all when I write my paper on An Ethical Delimia I Encountered During Clinicals~it brought up some very interesting viewpoints.

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Specializes in Cardiac, ER.

I mentioned this in another thread,.but I gave a placebo for anxiety in the middle of the night once,.with out an order,.(no a good idea by the way),..any way it worked like a charm and the pt slept like a baby until time for her angio. My thoughts at the time, and now,.are that I'm there to care for my pts,..if what I give them works,.takes away their pain or anxiety,.who cares if it's NS? The NS had zero side effects,..can't say that about ativan! FYI I didn't actually "lie" to my pt,..I told her that I had "something" that I thought would help her relax and sleep,..I did dramatize a bit and ask her to get into bed before I gave it and asked that she please ask for assistance before getting out of bed if it made her feel "woozy",...her husband was there and knew what I was doing and she was asleep in 30 minutes,..so was he :yawn:

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