Patient Autonomy

[TGood]

A patient has a known overdose history for pain medication. She has since been put into a long term care program and receives pain managment both on a routine and prn basis. Her husband requested to give her the least amount of pain medication to keep her comfortable. She is constantly asking for medication. Is it wrong to inform her of her husbands request?

[loriangel14, RN]

Is the patient lucid or is he the POA directing her care?

[TGood]

Very lucid and can manipulate.But is very aware of what is going on.

[MunoRN, RN]

In general, it's not a bad rule to give only the amount of medication required to achieve adequate pain control.

Yet unless the patient has been declared incompetent and the husband is the surrogate decision maker, he really doesn't have much control over that. Otherwise it's up to the patient and her doctor and Nurses to come up with and implement the pain management plan.

[TGood]

She has a prn q 4 hours that she can have.The problem is another caregiver believes she is just seeking a high and does not want to give her medication. Caregiver #2 informed her of her husbands request and caregiver #1 stated that by telling her of her husbands request it is a form of abuse to the family and breaking their confidentiality.I told her I believed it was the patients right to know but I just want to be sure I am giving her the right advice

[rn/writer, RN]

A patient has a known overdose history for pain medication. She has since been put into a long term care program and receives pain managment both on a routine and prn basis. Her husband requested to give her the least amount of pain medication to keep her comfortable. She is constantly asking for medication. Is it wrong to inform her of her husbands request?

Are you honoring his request? If so, that's a problem. Her husband can request anything he wants, but unless she has been declared incompetent and he is her HPOA, his choices and preferences are immaterial. Her pain management schedule is between her, her doc(s) and her nurses.

Now, if you're asking if she should be made aware that he's making requests like this behind her back, I suppose that's a judgment call. You're not obligated to tell on him, and doing so might open a real can of worms between him and his wife. But you're the one in the thick of things, so it's up to you.

What you might want to consider is a social services consult to see if there are conflicts regarding her medication schedule that can be resolved. Or you may need to see if the husband understands the plan and how the meds are supposed to work. She might even need that, too. It's amazing how many patients and family members don't understand a lot of the basic concepts involving meds. They need to be taught about the differences between short- and long-acting meds, dependency vs. addiction, preventing pain vs. chasing it, etc. Loved ones are often opposed to narcotics for even severe, intractable pain because they haven't been properly educated (and they're not the ones feeling it!)

Back to your original question, when competent adults are involved, I really dislike behind-the-scenes finagling. I'm not saying such communication is never appropriate, but in this case it seems like he may trying to pull strings in his own way to offset her manipulative behavior. I'd think long and hard before getting in the middle of something like that.

[MunoRN, RN]

Did caregiver #1 tell her that to justify not giving her pain meds? I don't think the issue is as much about confidentiality as it about the fact that it doesn't really matter what the husband thinks. You've got an order that says to medicate for pain, the patient is reporting pain and the husband is not the decision maker.

Sometimes patients are "seeking" but often what we refer to as seeking is just how people respond to poorly controlled pain. Either way, it's up to the Doc to make that decision and limit the availability of pain meds. If the patient meets the indication for med, and has none of the contraindications (such as oversedation), give it. Otherwise this sort of sounds like Nurse assisted spousal abuse.

[OCNRN63, RN]

The patient should be medicated according to her pain level, not what her husband wants.

[TGood]

I am not aware if he asked this to be kept confidential.I believe it was just implied. I just feel bad this nurse is being threatened by this nurse and accused of abuse. It doesnt sound like abuse to me but I am no lawyer.

[loriangel14, RN]

If the patient is competent then it doesn't matter if the husband wants you to with hold meds or not.You are going to be aiming to control her pain with as little meds as possible anyways.I wouldn't repeat to the patient what her husband had requested.You don't want to get the middle of family issues.

[umcRN, BSN, RN]

It's amazing how many patients and family members don't understand a lot of the basic concepts involving meds. They need to be taught about the differences between short- and long-acting meds, dependency vs. addiction, preventing pain vs. chasing it, etc. Loved ones are often opposed to narcotics for even severe, intractable pain because they haven't been properly educated (and they're not the ones feeling it!)

I know this is a side note but this really drives me crazy especially when it's a parent who is upset that their infant/child is recieving narcotics, oh you know, 4 hours after a large surgery like open heart or abdominal surgery...ugh just irks me!

[xtxrn, ASN, RN]

I am not aware if he asked this to be kept confidential.I believe it was just implied. I just feel bad this nurse is being threatened by this nurse and accused of abuse. It doesnt sound like abuse to me but I am no lawyer.

If he is not the POAH, or a resident- there is no privacy for him.

If she's in pain- medicate. If he IS a pain, social services :)

What a cluster.