Now my employer has threatened us with calling the BON if we don't get a pain scale...

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...for all prn pain medications. Say if a doctor prescribes Tylenol "for fever of xxyy" and a nurse gives the medication when a patient has a headache and is asking for the Tylenol...

they say they will report such an infraction to the BON.

And if there's a pain medication without a scale entered in at all (doctors give/enter orders)... it has become a problem for us. We need to call and get a scale to administer the medication by.

Why? because we need to record the patients' pain level using one of three pain scales before administering.

Say if Percocet is ordered "for pain level 5-10" and the patient says "4" or whatever...it becomes a problem and a reportable offense!

Is this even right or ethical?

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While "reporting to the BON" sounds overboard and ridiculous, you do need a pain scale. Technically, you should call the doctor, but I never do. I just add "moderate", "mid" or "severe" to the order (if the MD does not) ...and it's never been a problem.

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Specializes in Critical Care.

Seems like we just went through this, but no, there are no BON's that will care if you are administering pain medication without the order having a defined dose based on pain scale level, that is actually bad practice.

Prescribing a specific dose, based on a unimodal pain intensity rating, is not appropriate or safe.

http://americanpainsociety.org/uploads/about/position-statements/ps-opioid-dosage.pdf

You do need some sort of indication for the med, so if you're giving tylenol for pain when it's ordered for fever that's technically a med error (although it's not uncommon). At least with the BON's I've worked with, if a hospital went to a BON and tried to report nurses for not having the proper indications, the BON would most likely turn that back on the facility and ask why the facility is unable to manage this problem, and if they can't manage this problem then they would ask if the hospital administration is so inept that maybe they shouldn't be allowed to remain open.

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Specializes in Trauma Surgical ICU.

Oh yes, my NM is pulling the same thing. Say the pt states their pain is a 5 but wants a Percocet and the order states Percocet for 2-4 on the pain scale and we give it anyways, we are " practicing outside our scope". Because the order states a pain level of only 2-4 we legally shouldn't give the Percocet. We should be giving meds with a higher pain scale. Ugh!!!

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MunoRN, yes we went through this before.... the only difference in my case is that e months prior my NMs would make these creepy kind of unbelievable verbal threats..now there's a whole inservice and power point devoted to this topic.... it seems more official. Like a circus tiger, I continue to jump through the hoops they place in front of me! lol!

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Specializes in Oncology.

I think giving medications for an indication other than the ordered one is a whole different ball of wax than giving them for pain outside of the ordered scale.

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Again, this is a problem to take up with the providers, not with nurses. If you have to have a pain scale to meet government regs, the providers can always write "for mild, moderate, or severe pain" as the scale.

Your management is weak.

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