Patient complaint - Did I mishandle this situation?

[lily8424]

So I got my first patient complaint. Without going into much detail, I had a patient who was on IV Morphine q 4 hours. Patient was reporting pain in middle of night. I administer medication to said pt. I check up on patient half an hour later and he is sleeping. 2 hours later, patient is reporting pain again. Patient has order for Tramadol q6 and I offer it to him. Patient states medication doesn't work for him but states they've been giving him Percocet q6h. I check the MAR again and the attending DC'd the order. I explain that to him that order was DC'd. Patient is upset about this but I tell him that I will reach out to Dr. I explain to Dr that patient states tramadol doesn't work for him and had been on Percocet q 6h. On call Dr states they are trying to wean him off the Percocet and told me to have him wait for the morphine. I check on patient again to explain the situation but patient is asleep again. I rounded on patient again when morphine dose was due but pt was still asleep and I didn't even know if he'd want it instead of Percocet so I decide to let him sleep. When patient woke up in morning, I offered morphine again to him but he refused, stating he didn't have pain and didn't want it. I apologized and told him they were trying to wean him off the Percocet, but he told me he was going to write a complaint about me and wants another nurse and refused care from me. I had to get oncoming nurse to administer his morning med and vitals since he refused to allow me to do it. I documented my interaction with the Dr and pt but can't stop feeling like I failed this pt.

[NurseSpeedy, ADN, LPN, RN]

On 3/6/2021 at 11:49 PM, SilverBells said:

Hard to say. That might have worked or you may have made him angry by waking him up.  I don't really see anything wrong with letting someone rest unless they specifically ask you to wake them up for all pain meds.  

Agreed. I have had post op orthopedic pain and I know when I was sleeping it was the only time I wasn’t feeling pain and would be really angry if someone woke me up to ask if I needed pain medication.

I wouldn’t stress over having this one request another nurse. There seems to be a lot of pieces to this story that I would not be surprised if the doctor may have charted them as being “drug seeking”.  MD gets wind of him complaining about the staff the patient may find some more preferred meds disappearing from their PRN list....and requesting a different doc during  their hospital stay isn’t as easy as complaining about your nurse who did everything they could within reason to help them.

[JKL33]

13 hours ago, TxBSN19 said:

I disagree.  Any time you advocate for your patient is not a mistake.

Your comment doesn't address my comment. I didn't say that advocating for a patient was a mistake. I stand by what I said 100%. Just because a nurse believes they are advocating for something doesn't mean that their rationale or their desired outcome is appropriate; sometimes it isn't even justified at all on one account or another (such as risks vs benefits, scientific information available, etc.). In fact we are discussing this very thing on another thread currently.

 

13 hours ago, TxBSN19 said:

Pain is what the patient says it is...remember nursing school? 

I do remember nursing school.

I also did not contradict the idea of a patient's perception of pain.

 

13 hours ago, TxBSN19 said:

I don't believe it is a mistake to ask the doctor for a different pain med because at least you are doing something. 

I don't agree with your rationale here.

 

13 hours ago, TxBSN19 said:

As hard as it is sometimes to believe how much pain the patient is in, you are to treat it as the level they say it is.

I didn't say anything about believing or not believing how much pain the patient is in.

And while I agree that I would try to intervene therapeutically to decrease pain/increase comfort, that fact itself does not dictate what the appropriate intervention is.

[Stillcrazyafteralltheseyears]

Yep I agree I think he was using intimidation to manipulate you.

[2BS Nurse, BSN]

Ha! I deal with these patients all the time in the outpatient setting. When a patient doesn't get what they want, they write nasty messages to my provider about me through MyChart messaging. This is why we have to waste so much precious time charting every flipping detail! It's self defense charting!

[Davey Do]

On 3/9/2021 at 1:27 PM, amoLucia said:

 Everybody & anybody reads these posts here, so just to be safe ...

Amen to that, amoLucia!

At my firing, the HR director, Rita Weasle, at Wrongway Regional Medical Center a year ago, had a whole notebook filled with copies of posts that I had made here on allnurses.

This is an example:

Rita cautioned me on my way out of her office, "If you continue to post about Wrongway on allnurses, the hospital will take action!"

Okay...

 

[amoLucia]

DD - I think what really solidified my understanding of the 'everybody & anybody' intention was a post here on AN maybe 3 or so yrs ago (?). A nurse had posted some not-so-nice disparaging information re her employer. Unfortunately she named the facility in her post.

An HR rep from that facility subsequently posted here wanting to talk with the orig poster ''to discuss matters' or something. This was AFTER the HR rep read the post here. That floored me!

No facility wants negative information posted on social media about itself; so whether that HR rep wanted to do 'damage control' or was sincerely interested in assisting the OP is unknown. I've suspected that there have been 'other' postings here when a respondent was more than just 'unknown'.

 

[Orca, ADN, ASN, RN]

On 3/6/2021 at 8:46 PM, lily8424 said:

I feel like I maybe should have woken him up to administer the morphine? I read on here that sleeping is often a coping mechanism for pain. 

My experience has been just the opposite. Patients who are in moderate o severe pain generally have difficulty sleeping. I see no need to awaken a patient to offer analgesics.

[MunoRN, RN]

On 3/13/2021 at 10:14 AM, Guest1157066 said:

If the morphine is scheduled q4h then yes you should have given it to him.  If it is PRN, he has to ask for it.  If he was asleep, he is comfortable.  A pt in true pain won't be able to sleep very well.  I hear many pts tell me a certain pain meds don't work.  We have to at least call and ask Dr as it isn't our place to determine which pain meds the pt can have.  Sometimes it doesn't matter what we do because not all pts can be pleased all the time.  As a nurse, you advocate for your pts but sometimes drs get in the way and won't prescribe more meds.  All you can do is educate and offer what is available.

This claim comes up a lot, and it's ridiculous.  

Nursing assessments of their patients shouldn't be by request only.

[neuron]

On 3/6/2021 at 10:58 PM, Wuzzie said:

However, his medical team should have informed him that they are changing his pain management regimen and why. 
 

Just curious,  how often does this happen? That the doctor doesn't do this themselves and lets the nurse be thrown to the wolves?