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

[beetlebailey524]

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!"

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.

[akrn70]

I'm going to have to agree with the rest...totally unethical! I have never seen it done and you are right for questioning the order. It makes me soooo mad when I have a pt in pain and it is put off becuse it's thought that the pt is drug seeking. I don't know if this is the case here but that's the first thing I thought of. I have seen doc's and nurses not give pain meds because this is what their thought process was. Good luck on your paper!

[nrsang97, BSN, RN]

No. I think giving a patient a placebo instead of really treating their pain is unethical.

That was my initial reaction when I read the post. That is totally unethical.

[nrsang97, BSN, RN]

She will be aware when I write the paper for her class:) Other students in my class have encountered the same thing. One girl said her preceptor actually gave a saline injection for pain relief to a patient in an ICU! It's amazing how nursing school does not prepare you for the "real world" of nursing. I have seen so many things we are taught not to do-I'm staying true to my beliefs and maintaining my integrity regardless. I have worked to hard!

I did work with someone who gave IVP saline and told a pt it was fentanyl to see what happened. The pt kept asking for fentanyl and the RN kept giving saline. He was in charge. I did tell him that he shouldn't keep it up and that would get him in trouble one day. He is no longer staff on my unit. Scary though that some will do that.

[truern]

While I completely understand that the placebo thing is BAD, and I know that it is unethical, I would never do anything unethical. What about those extreme cases where the patient is MAXED out on very strong pain relief meds and if you give her anything more she will pass out and quit breathing...

Yet, she is still begging for pain relief. All tests have been run, there are no new acute things going on and you are sure of it,, and the patient, as long as her eyes are open and she is conscious keeps begging for more pain meds. And you KNOW that you've given her enough to kill a horse.... then what? The doc wants you to try an IV placebo...... you can't give her any more pain meds because she might stop breathing and DIE. So, you tell the doc,,, hey doc,, you give it because that is unethical and I won't do it.......... Then guess what.........

The doc gives it,, ,and the patient finds relief.

You can't tell me that it did not work. It worked. It happens, and it works.

However,. only in those extreme circumstances where you know that the patient is already so full of narcotics that if she gets anymore she will have to be intubated. If the patient is wanting the pain med that bad, she is not thinking about anything else. Maybe her pain is really bad like she says, but I've seen people that are so narc'ed up that there's no way they can even feel their fingers and toes. They can barely talk because their lips and tongue are numb and their face is droopy... and THEY STILL WANT MORE.

Instead of telling them,, there is no more, you can't have any... why can't the doc give a NS IV Push? just to give the patient relief that we are trying something, instead of not doing anything, because we can't give her anymore?

I understand that if it is allowed in those extreme circumstances that it would eventually be abused and the people that really need pain relief would be denied, and that's where I have a problem. I have been in pain before, and so have every one of you. There's no way that I would be alright with someone giving me a placebo, UNLESS they have maxed me out so far on narcs that they are afraid to give anymore. At that point, if someone is still in such bad pain that they need more meds,,, they SHOULD BE INTUBATED AND PUT TO SLEEP for a while. dang..

I had a root canal yesterday...came home, took 1 Vicodin. 45 minutes later my jaw was KILLING me, took 1 more Vicodin. I couldn't talk right, I couldn't stand up straight...but my jaw was STILL KILLING me!! I kicked the Vicodin with some Aleve and went to sleep hoping to wake up relieved.

Sometimes the side-effects are evident, but the pain relief isn't happening...sigh.

[rn/writer, RN]

I understand why placebos are generally not allowed. I also understand that in rare circumstances they might be useful and could give a patient genuine relief. The problem is that coming up with rules and regulations that would define ethical exceptions for those rare circumstances but still protect the other patients for whom a placebo is definitely not the right choice is well nigh unto impossible.

By prohibiting the use of placebos across the board (except for research protocols), we deny the use of a helpful tool to a small number of folks and their docs and nurses, but we protect much larger numbers of patients who would suffer from the misuse of such a tool. It's sad for the few who could benefit, but, human nature being the corruptible little attribute that it is, I don't really see any other option than to look out for the majority.

Speaking of human nature, just having the use of a placebo as an option could offer serious temptation to anyone thinking of diverting. Addictive thinking is always looking for new ways to rationalize.

[WalkieTalkie, RN]

This thread reminds me of a nurse I used to work with. He told me that "back in the day" he used to give "Salinol" to his drug seeker patients when the MD wouldn't give them any IV pain meds. Guess what "Salinol" is? Just a saline flush. He certainly doesn't do this any more, but the story is amusing.

[leslie :-D]

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

teh.

your, "i didn't lie" statement, reminded me of when president clinton wagged his finger in the air and boldly stated, "I DIDN'T HAVE SEX WITH THAT WOMAN".

my point being, that nurse/pt relationships are based on a covert trust that pts place on us.

that, even in the absence of a verbal contract, pts go in the hospital assuming we will take care of them.

telling a pt that "you have something for them" is deceitful, knowing they would have expected an anxiolytic or a comparable med.

and even worse, knowing how it was played up.

i'm glad it worked for her.

and no one is minimizing the potential effect of placebos.

but as long as the pt hasn't been informed that they may be receiving placebo meds, it remains unethical.

it really would have been worth the extra time, to get an order for an ambien/ativan.

and, a few minutes of 1:1, would have likely been most helpful.

whatever.

people are going to continue with these methods as long as they see nothing wrong with it.

this is only my .

leslie

[shelly304]

I worked with a MD in the ER six years ago. He was not on staff. He constantly ordered for Obecalp until most of the nurses refused to work him and admin found out his little game. I think he was a disgrace to the medical profession. Patients deserve to be treated with respect. They deserve to trust us. Actions like this only serve to fuel the patients mistrust of the doctors and nurses who work hard to provide the care they have come to us to recieve.

[Scubadiver]

I have been a nurse for 33 years and never once seen an order for a placebo. It is highly unethical. I am also trained as a pain resource nurse and am a certified palliative care nurse. As such I am well trained in pain management and the barriers to good pain control. That physician is one of them.

[Tweety, BSN, RN]

Only once in my career many years ago back in the day did I give a placebo, and it was effective in relieving the patient's pain.

I now work in acute care med-surg trauma and placebos aren't given.

Call me deceitful and unethical. Some of the off-the-hip quick judgements aren't going to make me feel like a bad nurse at all. The caviet is that I wouldn't do it now in the setting I'm in, and no one is writting them anymore so it's a moot point.

[66HotelMikeFive]

Two things I have learned in my three years of nursing: 1) if it doesnt feel/sound right, its not. 2) If it crosses your mind as something that should/or shouldnt be done then follow through.

I would have no part of that order.

The beauty part of military nursing is that sometimes, not always, but sometimes you out rank the doctor. :)

[PedsAtHeart, LPN]

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

But IF the placebo IS treating the pain, makes the patient feel better, then how is that inadequate pain control??