overdosing in the PACU

[marcyga]

This is the first time I have done this so be easy with me. I have a really huge problem here at work. I do the quality improvement at our facility, and we are running into a BIG PROBLEM. We are getting patients back on the med/surg floor from surgery and they are going into respiratory arrest from too much pain med in the PACU. Then the patient comes to the floor still complaining of pain, so the floor nurse will give a dose that the physician has ordered. Do any of you know if there is a policy in your facility that states how long a patient must wait or some kind of assessment criteria for giving meds after the patient returns to the floor from PACU. Thanks for your help.

[BadBird, BSN, RN]

Usually the patient must have stable vital signs for at least 1 hr. prior to transfer to the floor. Sometimes on nights we have to recover patients in ICU too.

[purplemania, BSN, RN]

Have you investigated to see if the same staff is working when these "incidents"occur? Sounds suspicious for impaired nurse/drug theft. Otherwise, I would think the floor nurse would medicate just as if the last dose were given on his/her floor.

[petiteflower]

We too have a 1 hour time in PACU and then they are dismissed to the floor if vital signs are stable and pain is under control.

[jemb]

When I worked on the floor, the report from PACU included info on the most recent pain med the patient received- dose, time, etc. The floor nurse would take that into consideration when implementing the floor orders.

In case I'm not being clear, and example would be: Pt had 100 mg. meperiedine IM at 1010 in PACU. Floor orders are meperidine 75 mg. IM q 3 hr. prn. 1st dose given on the floor would be at 1310. (Sounded to me that you were saying the floor nurse implements floor orders without taking prior doses into the formula.)

Actually, when I left floor nursing, most post-ops were coming back with orders for PCA pumps with a very low basal rate and 10-15 minute lockout. That seemed to work quite well for most patients.

[marcyga]

Thanks for your help. This is what is happening, the floor nurse is giving pain meds as if there had been nothing given in PACU.

[New CCU RN]

Well, it sounds like the problem is on your unit, not the PACU. I don't understand why nurses on your floor wouldn't take into account pain meds given in PACU.

[nimbex, RN]

not on the floor, but do get patients post one hour PACU. We MUST have Narcan/Romazicom taped to th IV pole. We have a policy that allows nursing to administer with decreased LOC and breathing.

Are you MD's writing a scale of pain meds? Ie. morpine 1-10 mg?

Perhaps the dose is too liberal, and / or your nurse cliician, clinical instructor needs to have a mandatory post op/pain meds review that includes a post test.

good luck