No More Demerol?

Home Health Columnist / Guide · Dec 13, 2005

Check our previous thread: No More Demerol IV Push???

Tweety, BSN, RN · Dec 13, 2005

That's an odd substitution. Wonder what they do if someone's allergic to morphine and dilaudid?

We still use Demerol although the MDs are sent a note that our facility recommends Morphine as the drug of choice for pain relief.

It's not because it's the drug of choice of drug seekers, but mainly the side effects, such as seizures, etc. that have made demerol fall out of favor. Drug seekers seem to like Dilaudid just fine in my experience.

I still like the Demerol option for people with allergies or who complain of ineffective pain relief with morphine.

Thanks Karen, I was just going to look for that thread.

General E. Speaking, RN, RN · Dec 13, 2005

hadn't realized this was discussed- thanks!

chris_at_lucas_RN, RN · Dec 13, 2005

Our hospital has a policy that allows pharmacy to change every order for Demerol to Dilaudid. I was talking to the chief of staff and he said that Demerol is the drug of choice for those "seeking" narcs. I understand the reasoning, but wonder why they don't target the docs who keep writing the Demerol orders in the first place? One day the ER nurse was giving report to me and mentioned a PRN Demerol order for the floor. When I mentioned it would be switched to Dilaudid- she had never heard of about it. The switching of certain drugs by pharmacy happens regularly and is true for many drugs (not just narcs). Some of our doctors are resistant and continue to write for the very drugs that are always changed. I was joking with one pharmacist and mentioned that before long we won't even need physician's. She looked at me (without cracking a smile) and said I was right. I value our pharmacy staff and would like to think that the changes are made to benefit the patient and are not totally focusing on the bottom dollar.
I am wondering what goes on in other hospitals?

Ummm, I think dilaudid is pretty popular with addicts too, isn't it? (High street value, last I heard.)

I think your point is well taken. Pain meds are always going to be risky for habituation. If people have pain, it should be managed with appropriate meds and other interventions.

At our hospital, we were told not to give prevacid if it was ordered, that we are now only giving protonix. LOL, nothing about addicts and GERD meds (we are a psych hospital) and no explanation for the change in policy.

I'm assuming we got a better deal from the protonix people.

elizabells, BSN, RN · Dec 13, 2005

I'm in nursing school now and we've been told several times in various lectures that Demerol is being phased out bc of side effects, and that if we become NPs we shouldn't write for it.

Katnip, RN · Dec 13, 2005

It isn't because of addicts. It's because of the potential nasty side effects of Demerol and the fact that there are drugs out there that are usually more effective.

Our hospital stopped using demerol on the floors and the only placed it's stocked is in the ED pyxis and the pharmacy. ED uses it because it's usually only a one time dose. But even there docs order it rarely.

suebird3 · Dec 13, 2005

:offtopic: Sorry about the "off topic".....but as to the Protonix/prevacid bit? One of the local hospitals ALWAYS changes our residents to Protonix when they are admitted. We change them back to Prevacid, as Public Aide will not pay for Protonix. It is the bottom line bit. I am pretty sure kick backs, too.

Ok....sorry to derail the thread.

Suebird

Ummm, I think dilaudid is pretty popular with addicts too, isn't it? (High street value, last I heard.)
I think your point is well taken. Pain meds are always going to be risky for habituation. If people have pain, it should be managed with appropriate meds and other interventions.
At our hospital, we were told not to give prevacid if it was ordered, that we are now only giving protonix. LOL, nothing about addicts and GERD meds (we are a psych hospital) and no explanation for the change in policy.
I'm assuming we got a better deal from the protonix people.

Larry77, RN · Dec 13, 2005

We still have Demerol stocked in our pyxis...even as a PCA med!...although I have not seen it used since I've been there. We usually start with MS PCA and switch to Dilaudid if needed (SE's or lack of px relief). Unless of course there is an allergy to MS. If pt states allergy to both they usually are given an Epidural with a button (PCEA). Our pharmacy has numerous meds that are auto-subbed but mostly for insurance reasons (ie. Prevacid subbed for Prilosec).

pricklypear · Dec 13, 2005

We still use demerol, but not often. It's usually prescribed by one particular doctor, and usually only on pancreatic patients.

Our pharmacy auto-subs tons of drugs.

Jenneu · Dec 13, 2005

We use it for rigors during bone marrow transplant and if the premedication for amphoteracin B doesn't work. For pain relief we use either morphone or dilaudid.

Daytonite, BSN, RN · Dec 13, 2005

Most hospitals pharmacies have developed formularies and rules that allow them to automatically change certain drugs that are ordered by physicians to what their formulary allows. They do this mostly for cost savings as many times there are drugs that are similar, but less costly. This is why you will see doctors order one medication and the pharmacy sends up something different. The pharmacists are supposed to come up and write the replacement order on the patient's chart (they are allowed to do this). In one place I worked the pharmacy had a stack of doctor's order forms themselves and just wrote the T.O. after notifying the doctor what they were doing. They would then later add the doctor's order to the chart. If you think doctors can give nurses a hard time, you should hear some of the terrible things they say to the pharmacists when they call the docs to notify them they have to change the drug they ordered to something on the formulary. The docs get pretty nasty with the pharmacists sometimes too. Pharmacists are also able to take physicians orders with regard to the dispensing of medication. We nurses don't have a corner market on taking doctor's orders. There are three pharmacists in my family, so I hear about this stuff a lot. In any case, all information about the hospital formulary of drugs is available to each physician who has admitting privileges. Some keep up with these changes, a lot more don't and most hear about it from a pharmacist who calls to tell them they have to change their order. Some docs go to the medical staff meetings where these things are decided and voted on, but a lot more of the doctor's don't bother. So, the pharmacists kind of act as a gatekeeper of the formulary. That's what's going on here. It is not a question of the pharmacy taking over. These are decisions made within the system for a number of reasons. This switch from Demerol to Dilaudid is becoming popular. If you've never had the joy of having this medication let me tell you that it's great if you're in pain, but makes you fell sick if you don't have pain. I don't know exactly why that happens, but someone has figured out that it's a solution to dealing with the Demerol seekers. Nurses are not consulted or have any part in the decision making on these issues. Sorry.