Opioid IVP Rate Compaint-too slow/Worried Rant

Middle Aged Newbie · Apr 13, 2008

Long time lurker, 1st time writer. Very helpful site - thanks!

Couldn't find this issue listed.

A patient complained i didn't push her 4 mg dilaudid fast enough.

The patient has had long-standing pain issues.

I double checked my PDA after to confirm, min 2 minutes.

The patient wanted the charge nurse, who went in with me on the next occasion to coach me faster - 30 seconds.

I have seen others administer much faster than I learned in school, also.

I have been encouraged to consider using smaller amounts before, between & after to flush, to help me speed up.

The good news is my preceptor called the doctor who manages the patient's pain & got the PCA adjusted to better meet the need.

I am almost done with orientation. So, on a busy med-Surg floor, which they try to keep surg, & I have 5-6 patients, how does one manage:

q 15 minute neuro checks 1 pt, x 1 hr, q 30 x 1 hr, q 1 hr x 4 hrs, then q4

q 15 minute vs on same pt w/similar reductions over time.

q 15 minute dopplers on another, with similar reductions over time

q 15 minute blood sugars on pt 1 &

2nd guy (got him shortly before 1st guy) similar reductions over time.

q 30 minute pain meds for breakthrough pain when pca insufficient on pt 3.

(This is the patient noted in the first paragraph). Also q 6 accuchecks, TPN. I Nurse Draw her labs through central line.

Incontinence on pt 4 & replace wound vac dressing he pulled out, confused (possible dementia) while waiting for the wound vac to be replaced.

Hep flush picc.

Cognitive impairment pt 5, she's a feeder, roll q 2. Long hx very labile HTN, repeatedly requests same meds, already given - sleeping pills, anxiolytics.

K & Mg protocol, No IV access, Crush pills & put in pudding. SMALL bites. Accuchecks.

Complex dressing change with wound manager pt 6. Also long hx of difficulty controlling pain & need for breakthrough iv pain meds.

Most have iv antibiotics every few hours

The day nurse (who precepted me once) asked why i hadn't gotten pt 5 soup.

I told her that I asked the tech (twice)

She continued to look @ me, unsmilingly.

I think she wants me to do it. I just can't. 12 hrs. No meal break.

Unfilled Linen Carts

Missed doses that must be requested from pharmacy

Handwriting worse than kindergartner's printing :bugeyes:

(I student taught kindergarten. Nurses computer document & chart)

Chart checks,

Adequate assessments

Care plans &

On-call docs who say "What do you want me to do about it."

When you call regarding severe HTN for which there are no PRN vasodilators. :banghead: (Most of the docs have been fine)

It would be nice to say the UAPs could do the vs, accuchecks & incontinence, but they are too few, overworked, underpaid & some shirk, as do some of my other co-workers.

The vast majority of my preceptors, who also often must charge, have been great - helpful & encouraging. I am also very lucky to have great co-workers-mostly. Sure there are some cliques. I avoid the gossip.

Working to overcome my perfectionist tendencies. (Some refer to as anal)

I'm learning bunches & love it, but I worry about the welfare of the patient & if I'm not up to the task of bedside nursing, I would prefer to get out before I hurt someone. I have been told I have good skills,

but must work on my time management. I will persevere. =):redpinkhe