Pain Dilemma Customer Service?

Nurses General Nursing

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Is it common practice to write a patient's PRN pain medication schedule down for them? Lets say you have a pt that has several PRN pain medications and also scheduled pain meds. The nurse from the previous shift tells you that they have been writing down this pt's PRN pain medications for him/her since this pt "constantly rings for pain medication" and "gets upset if you are even a minute late with the medication". Is that common practice I guess to treat PRN med's like scheduled pain meds (or should you wait for the pt to ring if they are starting to be in pain/offer PRN dose if they are complaining of pain?)

Also lets say the day of d/c this same pt asks for an additional dose of IV pain medication. You have already given the PRN IV med but they are requesting another dose (they are not complaining of pain at this time) but they want you to talk to the Dr. to have an additional IV medication as they say this is the only thing that works and they don't want to be in pain once they get home. You tell them that you will try to touch bases with the Dr, but usually you remove the iv on the day of dc. At the same time another one of your patient's is coming back from surgery and is screaming in pain....you immediately go to assess this pt, he's screaming and swearing in pain but there is nothing ordered for pain med's ...he's screaming and youre trying to touch bases with the surgeon to get something ordered for him. Meanwhile the other patient is ****** because you are late with the the final PRN pain med for him, another nurse d/c's this pt without this pt getting the IV med they wanted, and they end up complaining to your supervisor (that's the way you find out about it...nobody bothers to peak their head in the room with the screaming pt to let you know the other pt is requesting their medication...in fact the supervisor walks by without any regard to the fact that this pt is also in severe pain)... and all this is happening while your trying to get the second pt settled whose still screaming. Youre a bit concerned because this pt's site is bleeding more and more.

A few days later the supervisor fires you saying you did not adequately control the d/c'd pt's pain and purposely made them wait, accused you of calling this pt a drug seeker, (which you did not) and it should not be another nurse's responsibility to have given this pt the PRN dose and to have d/c them for you. I guess being new to this career... is this fair? What should have been done differently? One suggestion another nurse made was to just give the pt the pain med without scanning it and run back to the screaming pt's room (but I would not have been comfortable with this as what if I would have made a mistake with the med also I did not realize the pt wanted the PRN med at that time since I was never paged that they were requesting it or in pain).

Specializes in ICU.

Just wanted to say that we do not discontinue all IV meds 24 hrs before discharge. Apparently this is not "common practice" because nowhere I have ever worked did this. We did not give IV meds an hour prior to discharge, though.

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Thank you all for your input...receiving feedback from nurses experienced and have no motive besides wanting to help makes me feel a lot better about things.... and the profession in general... as the feedback I received from the manager/supervisor just did not sit right with me...I kind of felt like I was in the twilight zone with how things were handled. Anyway I feel better knowing that it did make sense to prioritize a post op...although I know that everything is a learning experience

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Specializes in Family Medicine.

Due to the customer service push, we're expected to write all PRN pain medications on the patients' whiteboards. Both the last time the medication was given and the next time it's "due" should be written.

Some of the whiteboards look like they belong on the front wall of a college lecture.

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Specializes in Family Medicine.

I should add, you didn't do anything wrong.

Your supervisor is a dimwit.

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Specializes in Med/Surg & Hospice & Dialysis.

It sounds like your fresh post-op needed more time in recovery if the pt was having that many issues.

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I think the very verbiage of saying a PRN medication is "due" at a particular time is screwy. This is why the non-medical PR people at the hospital should keep their noses out of nursing.

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Dearest applewhitern...

I think this is just a difference in policy/protocol. I have been a RN/BN for more than 21 years and it remains " common practice" that if a post op pt still requires IV med delivery, they are NOT fit to be d/c'd ( assuming a d/c is to their home). There are exceptions, obviously, such as day surg pt's, etc...but again...they are never given a " top up" for their journey home.

Typically, pt's are d/c'd with a Rx to be taken PO...and even THAT is pretty short term. ( as most of our MD's here are pretty tight- fisted with any narcotic pain med Rx.

But thanks for your input!

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It's sad in a way though that I have to rely on the internet to find an intelligent answer....the manager and supervisor of the floor (both RN's) were upset that I did not make it a priority to get this pt an additional IV dose before leaving (they mentioned customer service and yes he was being dc'd home with a prescription for PO pain medications). This particular hospital also does not have a written policy on IV narcotics...this made it even more of a challenge for me as I did not have anything concrete to go by. I appreciate all the responses...

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Specializes in Pedi.

A patient still requiring IV pain medication, IV fluids or IV antiemetics would NOT be a candidate for discharge, IMO. The exception would be the patient who is on IV fluid at home at their baseline or a patient being transferred to home hospice with IV narcotics. The typical post-op? Nope, you're not going anywhere if you're in so much pain that you need IV narcs. When I worked in the hospital, patients got IV narcs for about 24 hrs and then once they started eating they were immediately switched to PO. Once they were taking PO, all IV narcs were dc'd and unless something out of the ordinary happened (like they went back to the OR or had some unforeseen complication) they didn't get any IV meds for the remainder of their stay. Some surgeries warranted longer use of IV meds (possibly up to 48 hrs or so) but for the most part nope and certainly not when they'd been getting PO PRNs for days.

This sounds like an unfortunate situation but it sounds like this place is probably somewhere you're better of not working at anymore anyway.

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\ said:
Yes complete BS. This happens all the time. What kind of surgeon doesn't order PRN pain meds after surgery?

 

When I had my c-section there was some sort of issue with electronic charting so I was with out any form of pain management most of the time I was in the recovery room. Freaking torture. You'd think hospitals would have some sort of policy to prevent that.

In the mother-baby ward I was really grateful for the nurses that would right down the next time I could have my pain pills. It was nice to know when I could have them again, and I didn't have to bother the nurses too much.

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Specializes in Emergency, Telemetry, Transplant.
RNnur said:
I but they want you to talk to the Dr. to have an additional IV medication as they say this is the only thing that works and they don't want to be in pain once they get home.

If IV pain meds are the only thing that helps their pain, then why/how are the being discharged? I worked on a thoracic surg. stepdown unit. In preparation for discharge all IV pain meds were d/c'd and the pt was switched to PO meds...thought being, they could not be sent home if they needed IV meds to control pain. If they still needed IV meds, then other solutions were looked for.

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Specializes in Pain, critical care, administration, med.
Quote
Is it common practice to write a patient's PRN pain medication schedule down for them? Lets say you have a pt that has several PRN pain medications and also scheduled pain meds. The nurse from the previous shift tells you that they have been writing down this pt's PRN pain medications for him/her since this pt "constantly rings for pain medication" and "gets upset if you are even a minute late with the medication". Is that common practice I guess to treat PRN med's like scheduled pain meds (or should you wait for the pt to ring if they are starting to be in pain/offer PRN dose if they are complaining of pain?)

Also lets say the day of d/c this same pt asks for an additional dose of IV pain medication. You have already given the PRN IV med but they are requesting another dose (they are not complaining of pain at this time) but they want you to talk to the Dr. to have an additional IV medication as they say this is the only thing that works and they don't want to be in pain once they get home. You tell them that you will try to touch bases with the Dr, but usually you remove the iv on the day of dc. At the same time another one of your patient's is coming back from surgery and is screaming in pain....you immediately go to assess this pt, he's screaming and swearing in pain but there is nothing ordered for pain med's ...he's screaming and youre trying to touch bases with the surgeon to get something ordered for him. Meanwhile the other patient is ****** because you are late with the the final PRN pain med for him, another nurse d/c's this pt without this pt getting the IV med they wanted, and they end up complaining to your supervisor (that's the way you find out about it...nobody bothers to peak their head in the room with the screaming pt to let you know the other pt is requesting their medication...in fact the supervisor walks by without any regard to the fact that this pt is also in severe pain)... and all this is happening while your trying to get the second pt settled whose still screaming. Youre a bit concerned because this pt's site is bleeding more and more.

A few days later the supervisor fires you saying you did not adequately control the d/c'd pt's pain and purposely made them wait, accused you of calling this pt a drug seeker, (which you did not) and it should not be another nurse's responsibility to have given this pt the PRN dose and to have d/c them for you. I guess being new to this career... is this fair? What should have been done differently? One suggestion another nurse made was to just give the pt the pain med without scanning it and run back to the screaming pt's room (but I would not have been comfortable with this as what if I would have made a mistake with the med also I did not realize the pt wanted the PRN med at that time since I was never paged that they were requesting it or in pain).

This is a crappy situation all around. The charge nurse and/ or manager should have been involved in this to help you address this situation. My take on this is I would have addressed the post op patient first since the idiot physician didn't seem to think pain was a priority.

As for the patient that was to go home the physician needed to be called and come see the patient to address his poor pain management before he is discharged. I would have been clear with the patient telling him you understand his discomfort but you cannot give any I'V medication without a order or just prior to discharge for his own safety.

As for writing down when PRN's are due is a way of empowering a patient to participate and maintain some type of control over their care. Patients that either have chronic pain or are in the acute phases of their pain should not be on PRN medications so that they don't experience the peaks and valleys of their pain control.

Patients that are chronic pain often experience pseudo addiction and often accused of being drug seekers. So by letting them know when they are due and to call 15 minutes before so that if you are busy you will be reminded before the medication is late. Chronic pain patients who can get their pain addressed appropriately the " phony drug seeking behaviors will disappear.

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