Narcotics for LTC Pts with chronic pain

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Specializes in Geriatric/LTC, Rehab, Home Hhealth.

Narcotics for LTC pain management I have run into a lot of other nurses who do not give prn pain meds to residents in chronic pain....spinal stenosis, chronic joint pains etc. Unless they can ask for it that is...even then I go in on the weekends and find that some walkie talkies were denied their pain meds even when they were asked for ("I'll get it for you in a minute"). I thought that we were supposed to assess for pain and treat appropriately (some people can't ask for it but they are in obvious pain). Sometimes I'll write the S.O. for tylenol and try that first but when I've questioned when the ordered meds are not given I get "med seeking, getting addicted, doesn't really need it". These people are in their 70s, 80s and 90s. I know there is the assessments and cautions that go along with giving a narcotic (safety, BM patterns etc) but please, giving them medicine for pain isn't going to keep them out of college or functioning in a job. I think you can expect dependence for pts with chronic pain. I have heard that some of my residents are slipped tylenol during the week but this isn't documented. What do you all think?

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Narcotics for LTC pain management I have run into a lot of other nurses who do not give prn pain meds to residents in chronic pain....spinal stenosis, chronic joint pains etc. Unless they can ask for it that is...even then I go in on the weekends and find that some walkie talkies were denied their pain meds even when they were asked for ("I'll get it for you in a minute"). I thought that we were supposed to assess for pain and treat appropriately (some people can't ask for it but they are in obvious pain). Sometimes I'll write the S.O. for tylenol and try that first but when I've questioned when the ordered meds are not given I get "med seeking, getting addicted, doesn't really need it". These people are in their 70s, 80s and 90s. I know there is the assessments and cautions that go along with giving a narcotic (safety, BM patterns etc) but please, giving them medicine for pain isn't going to keep them out of college or functioning in a job. I think you can expect dependence for pts with chronic pain. I have heard that some of my residents are slipped tylenol during the week but this isn't documented. What do you all think?

I am with you 100% on that subject. I am a paramedic contemplating RN school (EC) and my mother is a nurse of 34 years. We have frequent discussions about physicians and nurses undertreating pain, for one reason because they are concerned about "addiction". :angryfire

When someone is in a LTC for the rest of their brief life....who cares if they get addicted. Don't deny them comfort in their last days.

I recently encountered a resident that was aphasic, with a hip Fx, with arm and leg contractures. She had been given tylenol. When I arrived the patient was crying. No she couldn't talk, but it doesn't take a rocket scientist to realize that she is in PAIN!!! So luckily I was able to get an order from the Doc for 5mg MS IM. By the time she was at the hospital she was sleeping. And in much less distress. I won't judge the nurse, because I don't know what the situation was prior to my arrival. But I agree with one of the other posts I've read. Don't apologize to the doctor for bothering them....it is their job to be bothered. :D

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Totaly unacceptable :angryfire I have the same problem, only I look like a pill pusher or that I "dope" everyone up. No...I medicate for thier verbal or s/s of pain. Pain is soo under treated in the elderly. There have been many a post on this forum. Bring this issue up with you DON. Maybe a few inservices from pharmacy could help. How about standing orders for pain meds? This could help. Remember to document.

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i just started my work as nurse extern at one of really good hospital at illinois. we have orientation where theyc were talking about pain assessmnet and managment. one of the wprkers talked about research which are done on it and this hospital was also included: how to manage pain and if there is risk of addiction (similar topic). what the educator told us is that per 100% people taking pain medication only 1% become addicted, and they compare it with smokers per 100% who smoke or take anything containing nicotine 90% become addicted. this is proved clinically (sorry, i do not remember name of woman who is leader for this research, but she was at my work place last year during nurses week at conference that include also pian managment). i just want to mention it because as student nurse on my clinical site i met lots of people neglecting right to recieve proper pain managment. lots of those pts were post op 1 or 2 days, some severe cases, and unable or ashamed to ask for it. no one can assume that pts do not have any pain. it is highly subjective. somettimes people will laught, will jump, will cry, will scream from pain but no one can say that it is not real. i wish at the moment when each of us making assessment nurses put oneself at your pt postion. what would you feel when other ignore your pain and right for control it, what would you feel when they left room and laught at you because you are asking for pain meds, or what would you feel if ask nurse for pain med and never get it at the proper time or not at all. we nurses are our pts advocates, not jugde, just stop and think what is your priority in your job performance. :)

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I have come across the same problem and it makes me so angry. Just because these people can't verbalize pain it dosen't mean they aren't having any. I watch for the non-verbal signs and give pain medication when needed. Sometimes that would be the only pain medication they would get. I don't understand why people feel they need to withhold pain medications. Is it a power struggle or what?

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I work in LTC (as well as on the acute psych unit) and I find at the LTC, nurses who give the ativan when the dear 90 yr old is getting agitated are blamed for "snowing" the residents. As I work in psych as well, and have had a similiar "dear 90 yr old" in 4 point restraints because the LTC didn't agree with sedating in the nursing home, I will freely give ativan or seroquel as needed. Better to have a resident sleep it off in their own bed than go off to psych for a few days of "stabilization". Agree about the pain meds...it is frustrating coming on shift and finding someone in pain, and seeing no prns have been given that day :angryfire

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Specializes in Geriatrics/Oncology/Psych/College Health.

Someone who is in chronic pain should have orders for scheduled meds, not PRN's only. This takes the guesswork out of it, insures the pt is being treated, and tends to reduce the "medseeking" behavior if the pain is controlled. Sounds like an issue for the ID care plan team.

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Specializes in Geriatric/LTC, Rehab, Home Hhealth.

Thank you everybody! We have our careplan RN coming in on the weekends to catch up on her work (bless her hert)...she's great though and I will talk to her about the two residents that I feel are being undermanaged at this time. I will mention that my unit manager is one of the nurses who is turning a blind eye and I actually got an informal warning from the third shift nurse that nurses that give "a lot" of narcs look suspicous. They can test my blood any day of the week, all they'll find is caffeine...lots and lots. I will also be sure to document as much as possible and I have started to do this in PIE form. Last weekend Mr. Q who had been able to ambulate short distances the weekend before couldn't even bear weight. I asked him why and he said "Its my feet, they've been hurting all week"...I reported this to...the unit manager via a comm book, careplans, alert charting etc."decline in function d/t pain and weakness" Thank you everybody again, its sad to know I'm not alone

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Someone who is in chronic pain should have orders for scheduled meds, not PRN's only. This takes the guesswork out of it, insures the pt is being treated, and tends to reduce the "medseeking" behavior if the pain is controlled. Sounds like an issue for the ID care plan team.

Good call. There are great extended release meds now - oxycontin, morphine E.R., etc. I'm horrified to hear how our elderly are treated in nursing homes as far as pain. I work ICU and overall we're pretty free with the pain meds and of course, sedation. I realize that nursing home residents aren't vented and monitored, but jeez, most folks can handle a couple of Percocet just fine.

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Specializes in Clinical Research, Outpt Women's Health.

Nursewendy2000 - I hope you will be my nurse when I am old and compromised. I think it is one of our nations worst and most shameful secrets. The under medicating of the elderly who depend on us is shameful. We sometimes treat our animals better because they live with us and we deal with them every day - while grandma is at "the home". Because providers (MD's, NP's, Nurses), not all by any means, but way too many of them, are afraid to be seen as prescribing or giving to much narcotic medication, these vulnerable elderly suffer. Sad, sad, sad. I hope the newer, younger nurses (and all nurses)will work to change this.

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It's our job to ease suffering isn't it? even if the pt can't verbalize pain we are not blind to objective s/s..not to intervene is neglect imo. If I'm 80 and addicted WHO CARES..gimme my pain meds or I'll come back to haunt ya!!! lol

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