Order that says "Don't call MD for pain meds"?

[Summers3]

Hello!

I recently took care of a pt with a foot fracture and he only had Tylenol for pain. I don't have any experience yet but I feel that this does nothing for pain of a foot fracture. And the pt is complaining that Tylenol does nothing for his pain...... However, there is an order that specifically states "Do not call the on-call MD for pain meds"...... Why? So the MD is aware of the pt's pain.... but does not want to give any other pain meds?

Sorry but I don't understand this situation... why not?

Thanks!

[Davey Do]

there is an order that specifically states "Do not call the on-call MD for pain meds"

So, contact the doctor who wrote the order and the not on-call MD and let the doctor know the Tylenol isn't relieving the patient's pain?

[heron, ASN, RN]

Doctor-shopping is a common strategy for many drug abusers. Typically, when hospitalized, they will wait until "after hours" to insist on calling the md in the hopes that a substitute unfamiliar with their behaviors will give them what they want.

This is why pain specialists insist that their patients get pain prescriptions exclusively from their practice. It's part of the contract they sign and is intended to control drug-seeking and manipulative behaviors. If your patient is known to abuse pain medication, the order is a reasonable one.

[RNperdiem, RN]

Sometimes in trauma, anesthesia pain service handles and coordinates pain meds if there is something complex involving an epidural with an epidural PCA and oral medication.

[KatieMI, BSN, MSN, RN]

Normally, tylenol works good enough for non-major bone fractures AND for "naive" patients.The doctor might have more information about the patient than you had, and/or his own history of opioid Rx "problems". Plus, yes, other service might cover for pain management according to facility's policies.

In addition to that, for some situations powerful pain-killers are contraindicated d/t risk of masking complications like compartment syndrome, nerve compression or vascular compromice. In such a case, if patient was post-cast/postop, the primary hospitalist wouldn't order pain meds without surgeon seeing the patient first.

[Jules A, MSN]

Excellent idea and to avoid those dreaded middle of the night calls I plan to add this statement to the admissions template on my psych unit. Just kidding folks.

[kbrn2002, ADN, RN]

My first instinct is to say this patient probably has a history of "doctor shopping" hoping a provider that is either not familiar with them or is too busy at an ED to look too closely at prescribing history will write an order for narcotic pain meds.

I actually have a resident in LTC that has a long history of med seeking with an order that all pain medication orders are to be approved by the PCP and all psychotropic meds are to be managed by her psych NP so I guess I don't find this kind of order unusual or inappropropriate at all.

[TruvyNurse]

If you feel the meds truly aren't working or are just wanting clarification. Call and ask! May get a grumpy doc, but you've done what you could do and went a step further being a patient advocate.

[AdamantiteEnigma]

If you feel the meds truly aren't working or are just wanting clarification. Call and ask! May get a grumpy doc, but you've done what you could do and went a step further being a patient advocate.

Agreed. Plus a little ice and elevation wouldn't hurt a thing. Just don't leave the cold pack on longer than 20 minute increments

[Here.I.Stand, BSN, RN]

If you feel the meds truly aren't working or are just wanting clarification. Call and ask! May get a grumpy doc, but you've done what you could do and went a step further being a patient advocate.

This. If nothing else, they can order some ibuprofen or toradol (unless contraindicated, of course) if they're not going to order opioids.

[Not_A_Hat_Person, RN]

I would call the doc who wrote the order and tell them the APAP isn't covering the patient's pain.

[SHGR, MSN, RN, CNS]

Normally, tylenol works good enough for non-major bone fractures AND for "naive" patients.The doctor might have more information about the patient than you had, and/or his own history of opioid Rx "problems". Plus, yes, other service might cover for pain management according to facility's policies.

In addition to that, for some situations powerful pain-killers are contraindicated d/t risk of masking complications like compartment syndrome, nerve compression or vascular compromice. In such a case, if patient was post-cast/postop, the primary hospitalist wouldn't order pain meds without surgeon seeing the patient first.

Agreed. I broke my foot a couple years ago and it just was not that painful even though it was a comminuted fracture. Ice and elevation really worked wonders. Obviously another patient's experience may be different, but after the initial snap it wasn't really that bad. (I just mean, don't assume that a fracture must be super painful).

Also, fun fact NSAIDS are seen as detrimental to bone healing Do Nonsteroidal Anti-Inflammatory Drugs Affect Bone Healing? A Critical Analysis