Confusion over pain med administration - page 3
I am orientating to a new hospital and while orientating on the floor, pain management was brought up between my orientator and me. My patient had an order for Norco 1-2 tabs every 6 hours. At the... Read More
Feb 22Occupation: Critical Care Specialty: 10 year(s) of experience ; From: US ; Joined: Nov '10; Posts: 9,344; Likes: 25,847Quote from djmatteProper nursing judgement according to professional practice recommendation is to base the timing of reassessments on both the onset and the duration of action. And while the JC used to recommend reassessing PO pain medication "within one hour", they dropped that recommendation in 2003 after it was discovered that 'recommendation' actually came from a faux-practice organization called the American Pain Foundation, which it turned out was a front group for a number of opiate manufacturers with the intention of encouraging overuse of opiate medications. (Dosing by pain score and 'pain is the fifth vital sign' also came from this group).No later than one hour after administration of any pain med. Nursing judgment based on onset of action. Also during normal vitals.
The current JC standard on pain reassessment is that "the hospital reassesses and responds to the patient's pain based on it's reassessment criteria". The hospital is only required to follow whatever criteria the hospital chooses. Requiring that pain must be reassessed and re-medicated "no later than one hour after" the initial dose is bad practice. The full effect of a PO opiate can take a full hour to occur, in most care environments, it's unlikely that a nurse can predictably be assessing at 59 minute mark, and if their reassessment must occur in less than one hour, then it's quite possible it's going to have to occur 15 minutes after it was given since there may not be another opportunity until 1 hour and 5 minutes after it was given. It's far more appropriate to reassess at 65 minutes than at 15 minutes and an effective an safe policy would have to reflect that. It's also unlikely that any physician actually intends that reassessments can't be done based on the known characteristics of the medication, so this would violate JC standards.
Feb 22Joined: Jan '08; Posts: 523; Likes: 946Our policy is to reassess for medication side effects and pain response... not redosing. An hour is appropriate for noisy PO opiates and much sooner for iv push meds. But I'm not here to discuss the rights of wrongs of our hospitals medication administration guidelines. Joint commission had no problem with them as written.
May 14Joined: Feb '10; Posts: 4,177; Likes: 5,847The order is poorly written. First it says give 1 or 2. Then it says give 1 and then a 2nd one in an hour if pain is still bad. So really there isn't an order to ever give 2 at once. And do the 6 hours start over after the 2nd tab?
An order that causes so much confusion just needs to be written over.