Only IM narcs post-op?

Nurses Safety

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Hi, I'm a new grad RN working in a neuro med/surg unit. I did the same thing as a nurse intern for almost a year at a different hospital. The current hospital I work at has a neurosurgery group whose standard post-op orders ONLY utilize IM demerol/vistaril or IM morphine for back surgery patients. These patients are usually laminectomy patients who have minimal (rated "3-4" on a 10-point scale) pain. They don't order IV morphine/dilaudid (for example) even if the patient has IV access.

Oh, and this group also doesn't order PRN muscle relaxants.

I have NEVER heard of this practice for post-op patients. I have a moral problem with giving IM injections when the painless IV route seems more appropriate in this population. In my nursing program, lecturer after lecturer talked about avoidance of "painful IM injections to control pain". Of course I do give the shots because that is the only option these physicians give their patients. My first day on the floor I asked a surgeon if I could get the order changed to IV and she jumped down my throat, so apparently that's not an option.

Can anyone explain the rationale behind this IM-only practice and is it common where you live? Am I making a mountain out of a molehill?

---Kelly

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Some physicians have the twisted mentality that "If your'e hurting THAT bad, you'll take the shot"

Then on the flip side, IV administered pain meds have a quick onset, but generally only last an hour or two. IM shots usually work 3-4 hours.

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What Tink said..only rationale I could think of is the extended relief of the IM's..but dang..if you have IV access why not use it?..our post-ops have standing orders for pain relief meds IV q 1-2 hrs..also have po meds ordered when applicable..able to swallow,ect......I just know if "I" were the pt I'd want IV opposed to IM post surg.

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Specializes in Critical Care.

Some people like to be controlling...

Do it my way or no way.

Noney

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Specializes in Telemetry, Case Management.

I see that a lot too. I think the MD's here have the idea that it will curb "drug seekers" but if you've just been cut open, I think drug seeking is exactly what I'd be doing, I'd want drugs and lots of them to begin with!!!!! And to give it IM is just ugly in my opinion. If those docs were the patient, I bet they'd want IV drugs!

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Wow, this makes me VERY greatful to my neurosurgeons for ordering PCA pumps post op for my multiple back surgeries.

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Thanks everyone for responding! Luckily some patients get a PCA pump (e.g. spinal fusion with screws etc...), but most do not! I'm sick of leaving notes on the chart "Please order PO pain meds" or "Patient is complaining of muscle spasms". I just don't get it! The IM thing is OK if they only need like one shot total, but every four hours for a day or two and no oral pain meds until they discharge the patient? Goofy stuff!

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How about sitting down with your collegues and asking them why? I'd be curious too. Especially since I'm the one having to give the shot.

I'm not sure why we feel we cannot ask questions. When I was a new nurse and heck even now, I ask questions if I don't understand something.

Not all physicians will bite your head off if you ask.

"Hey, I'm new at this and just wondering the rationale behind IM injections versus IV injections." . .

Good luck. :D steph

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