Multiple Narcotic Administration

Sun0408, ASN, RN · Nov 20, 2013

If the pt is not new to narcotics, I will give PO and IV at the same time. Why, IV morphine does not last that long and will give the pt relief now, PO meds will take 45min to an hour to start working and will last longer than IV. So I do tend to give a little IV meds with PO for this reason..

If the pt is elderly,not used to pain meds or has compromised kidneys, I will space them out. We don't have a policy on this or a protocol, its up to the nurses judgement..

calivianya, BSN, RN · Nov 21, 2013

If multiple narcotics are ordered PRN, it is perfectly acceptable to give them relatively close together, assuming they are okay to receive more based on your assessment of the patient. You said they gave them as close as 30 minutes together - I know I've done that, especially with IV narcotics. If the patient got IV dilaudid and only went down from 10/10 to 8/10, for example, and it's been half an hour and they are awake, anxious, breathing 30 times a minute, and the BP is 170/90, I will go ahead and give the PRN IV morphine ordered as well. IV narcotics are going to hit fast, and the patient should have relief of their pain within 1/2 an hour max. I will also absolutely be right on the minute with that next dose of q1h dilaudid/morphine/whatever until the patient's pain is under control.

If your coworkers were within the parameters of the written orders and they did not oversedate the patient, they did nothing wrong. I would only be concerned about it if they were doing the same with an 90 year old lady who is totally opioid-naive and has never taken a painkiller in her life, and continued to give her narcotics despite a hypotensive blood pressure and respirations under 12.

You can't really take a blanket approach to pain control. Everyone's tolerance is different, and every drug acts on every person differently. You really need to decide how to give the pain medications (within the parameters of the orders, of course) based on the patient's physical assessment. I guess my biggest question is, if you are concerned about the other nurses giving too much pain medication, is that concern based on clear oversedation of the patient as evidenced by the patient's level of consciousness, respirations per minute, SpO2, and blood pressure, or is it just based on what your opinion of pain control should be?

SouthernPoint · Nov 21, 2013

Here's what happened during my night. 20-something year old male. Status post femur fracture with ORIF post op day #3. History of multiple drug use. Complains of pain throughout the night. But requesting for Morphine IV and Tylox or Tramadol PO at the same time. States that nurses are giving them together. Checked the eMAR and noticed that nurses weren't giving them together. But were administering narcotics within less than an hour of each other as close as less than 30 minutes. I was totally against administering the patient's pain medication in this way. I explained side effects of administering multiple narcs at the same time and explained the hospital protocol. What would you have done? And what is your hospital's protocol for pain management?[/quote']
Your best answer is.. Check with your place of employments Policy & Procedures. If you can not find anything speak to a pharmist. Why do I say that. Because everyone will chime in saying this or that and guess who will be the person in trouble if someone checks your narc administration. You. So the best thing to do is look at your P&P and go by that.