Overuse of opiates?? Opinions?

Nurses Safety

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would like to know what your opinion is on an issue that has bothered me for quite a while. patients being admitted to medical/surgical units with various diagnosis, for instance "abd. pain, nausea, vomitting, " you know the type, frequent flyers who come in every other week with some imaginary ailment, and they always get a bed, and then get obscene doses of narcotics. i mean, 100mg of demerol every hour? or 25 of phenergen on top of the 4mg of dilaudid they are getting every hour via pca pump. is it me, or is there an epidemic of narcotic addicted junkies floating around the healthcare system? and does anyone else feel that the doctors are part of the problem? i'm growing more and more intolerant of this whole horse and pony show. after a night like last night it really makes me think about my career choice. :uhoh3: :uhoh3: :uhoh3: :uhoh3:

Specializes in Telemetry, ICU, Resource Pool, Dialysis.

Nut, people seem really vicious on this subject. I see your point, about the patient who simply will not be pleased. I think you are describing a patient who thinks that the more he complains, the better the meds will get. He doesn't realize that there is a limit to everything, and it is beyond your ability to manufacture the perfect medication for his discomfort. Then you have the doc who is frustrated and says "tell him NO more" Leaving you to deal with it. You can only do so much. It doesn't really matter what you think of his motives, your job is to assess and medicate. I don't consider myself a substance abuse counselor. I don't care if it is 2am, if the patient SAYS he's having pain, the doc needs to do something about it. Even if he gets a phone call every hour all night. I do think you should be allowed to vent without being attacked, though. That way you can get it out, and go back to work and do whatever you have to do. You were not by any means attacking everybody who complains of pain. You were not withholding medication because you though he was faking. You were just frustrated!! Chin up:wink2:

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canoehead: Sedation does not equal pain relief, also a basic pain mgmt. principle.

Why is it that when those of us who vigorously advocate for pain mgmt. speak up, the people who have a problem with certain pts tell us to lighten up..."we're just venting"? Well, maybe I am just venting too, after seeing pt after pt suffer unneccessarily because he didn't have adequate pain meds, or suffer because a nurse made him afraid he'd be an addict if he asked for his meds too frequently/became irritated with him because he needed his meds q 4h ("Clockwatcher!").

The most irritating factor is that many of the comments like those expressed here show that the "venter" has not bothered to seriously update himself/herself on the new principles in this area.

So, yes, I do get a bit hot under the collar. I was already chastized by the people in the ED forum for defending chronic pain pts., and now it's happening here. I guess I don't have the right to vent.

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Specializes in ER.
canoehead: Sedation does not equal pain relief, also a basic pain mgmt. principle.

I know that, but even if she is in pain should we let her kill herself with meds? Seriously, I don't know what to do in this situation, and it's not just one patient. Many, many patients come through my hospital, and we drug them until they can't walk straight, but their reported pain level remains unchanged no matter what med is tried. (I'm talking years of repeated admissions). If we give them narcs IV they report some relief, but only for a half hour or so, but the sedation effects last and last. Do we keep giving more med?

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Perhaps what should be looked at is which narcs are used, and if the docs are adding unnecessary sedatives. When a pt is in pain but is oversedated, the first thing you look to eliminate unnecessary meds that can cause sedation, not the narcs.

Perfect example: "Phenergan potentiates Demerol and makes it work better." Current studies have proven that it does not do that, that it adds to the sedation, and it actually lowers the pain threshold."

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Specializes in Utilization Management.

Our difficult-to-control cases warrant a consult to a Pain Management Specialist.

Takes the heat off us and the PCP.

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i believe the max daily dose of meperidine is 600 mg, or no more than 48 hours of therapy before d/c, else the patient runs the risk of neurotoxicity.

indeed, i once had the honor of calling a doc in the wee hours and informing him that his prescribed dose of demerol was too high and i wasn't going to give it, on the advice of our pharmacist.

doc transferred the patient off to another unit. patient got the med as prescribed--and went into convulsions later that weekend. :o

demerol is not an appropriate pain medication to give. period. except for some gi procedures. many hospitals are removing it from their formulary. i would be doing everything in my power to get the drug changed but some physicians are not knowledgeable about pain and do not easily change their practice.

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nut, people seem really vicious on this subject. i see your point, about the patient who simply will not be pleased. i think you are describing a patient who thinks that the more he complains, the better the meds will get. he doesn't realize that there is a limit to everything, and it is beyond your ability to manufacture the perfect medication for his discomfort. then you have the doc who is frustrated and says "tell him no more" leaving you to deal with it. you can only do so much. it doesn't really matter what you think of his motives, your job is to assess and medicate. i don't consider myself a substance abuse counselor. i don't care if it is 2am, if the patient says he's having pain, the doc needs to do something about it. even if he gets a phone call every hour all night. i do think you should be allowed to vent without being attacked, though. that way you can get it out, and go back to work and do whatever you have to do. you were not by any means attacking everybody who complains of pain. you were not withholding medication because you though he was faking. you were just frustrated!! chin up:wink2:
thank you for understanding the need to vent frustrations once in awhile
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canoehead: Sedation does not equal pain relief, also a basic pain mgmt. principle.

Why is it that when those of us who vigorously advocate for pain mgmt. speak up, the people who have a problem with certain pts tell us to lighten up..."we're just venting"? Well, maybe I am just venting too, after seeing pt after pt suffer unneccessarily because he didn't have adequate pain meds, or suffer because a nurse made him afraid he'd be an addict if he asked for his meds too frequently/became irritated with him because he needed his meds q 4h ("Clockwatcher!").

The most irritating factor is that many of the comments like those expressed here show that the "venter" has not bothered to seriously update himself/herself on the new principles in this area.

So, yes, I do get a bit hot under the collar. I was already chastized by the people in the ED forum for defending chronic pain pts., and now it's happening here. I guess I don't have the right to vent.

Of course you have the right to vent. I can understand what you are saying, and when I was a nsg student, I could never understand why some nurses got so annoyed when certain patients called out for pain meds. I told myself I would never be that way. But now I can understand both sides.

A few weeks ago I had the privelege of having one of our frequent flyers. This patient was abusive and manipulative, period. I'm sorry. I know we are taught not to judge, but when a patient screams at you for not bringing her PRN medication "on time" (she didn't ask for it) and refuses to listen as you try to explain that it is not scheduled, that she needs to let me know when she needs it, upsets her roomate, eats candy bars and drinks soft drinks while NPO with a dx of abdominal pain, well, I'm sorry. I'm not a saint and I'm not stupid, either. I think they have convinced themselves that they need it for an actual physical ailment. I know that they really do need it, I can see the elation as I bring it to them and administer it. I know they're addicted, and I'm not going to withhold it if it's ordered, but I can't help but be upset by it. It's like Tweety said, when you see that look on their face as you are pushing the drug, it's just so sad. You really do feel like you are shooting them up. Very frustrating to me as a new nurse.

BTW, FabFive, I was taught in nsg school the principles you talk about. Phenergan doesn't potentiate, just because the pt is asleep/sedated doesn't mean they aren't in pain, never judge, you can't rely on mannerisms and physical s/s of pain. Just thought you'd like to know that the updated info is being taught at least. :)

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i think there are 2 different types of postings on this thread.

1. there are the beliefs that whether one is addicted or not, never underestimate/disbelieve the pain relief they are seeking.

2. and then there are those pts. that are SO med seeking and do not present in any pain, using our assessment skills that we've been taught.

we need to differentiate between judgment and assessment.

because there are some of us that do not believe a patient is in pain does not automatically deem it a judgement.

but the bottom line is if there are orders written for prn or scheduled, then you give it.

if patient's behavior escalates with demands, then you see what you can do about it, and share your findings with the md.

but there is nothing wrong with limit setting and a firm but gentle "i'll see what i can do".

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canoehead: Sedation does not equal pain relief, also a basic pain mgmt. principle.

Why is it that when those of us who vigorously advocate for pain mgmt. speak up, the people who have a problem with certain pts tell us to lighten up..."we're just venting"? Well, maybe I am just venting too, after seeing pt after pt suffer unneccessarily because he didn't have adequate pain meds, or suffer because a nurse made him afraid he'd be an addict if he asked for his meds too frequently/became irritated with him because he needed his meds q 4h ("Clockwatcher!").

The most irritating factor is that many of the comments like those expressed here show that the "venter" has not bothered to seriously update himself/herself on the new principles in this area.

So, yes, I do get a bit hot under the collar. I was already chastized by the people in the ED forum for defending chronic pain pts., and now it's happening here. I guess I don't have the right to vent.

{{{{{{{Fab4.}}}}}}}}.....please don't ever stop venting. You stand up for all those who need advocates and those who can't quite express feelings they wish to sometimes write here, for fear of it coming out wrong.

I remember being told that we who represent the other side of the "pain" coin should just leave the venters to vent and start our own thread. The thing is....the other side of anything makes for a good discussion, as long as each side doesn't get too offended. Seems like that's pretty hard to avoid when faced with frustrated nurses dealing with all the "clockwatchers", FF'S, "drugseekers" and such. :o And vice versa!

One more thing...the OP did ask for opinions.

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FabFive

LOL...how old are you? Was that intentional? Please don't tell me you're too young to know the "Fab Four." I can't handle another reminder of my age today! :chuckle

I was taught all of those misconeptions back in the dark ages when I was a student.

z: Thanks!

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Specializes in ER, ICU, L&D, OR.
i think there are 2 different types of postings on this thread.

1. there are the beliefs that whether one is addicted or not, never underestimate/disbelieve the pain relief they are seeking.

2. and then there are those pts. that are SO med seeking and do not present in any pain, using our assessment skills that we've been taught.

we need to differentiate between judgment and assessment.

because there are some of us that do not believe a patient is in pain does not automatically deem it a judgement.

but the bottom line is if there are orders written for prn or scheduled, then you give it.

if patient's behavior escalates with demands, then you see what you can do about it, and share your findings with the md.

but there is nothing wrong with limit setting and a firm but gentle "i'll see what i can do".

Judge not lest thou shalt be judged

Assess. Intervene, Evaluate effectiveness of Intervention

Sometimes you need more medicine

Sometimes you need a swift boot out the door

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