Pca Problem

ytoni · Oct 30, 2003

Hi, you just did what a nurse should do. A patient is having a bad reaction to MS, and you did the right thing to stop the medication and inform the doctor.

DoctorRN · Nov 27, 2003

AMBOO,

All hospitals have a chain of command to follow. When you attempted to call the physician and could not reach him you should have instituted your chain of command to help resolve the issue. This takes the legal monkey off your back and places it on someone in hospital admin. It becomes the administrations responsibility to contact either the physician caring for the patient or the cheif of staff for the service he is on.

In my experience, it only takes one call from the hospital administrator or the Chief of staff to get a lazy doc off their butt to care for the patient.

Turning the morphine PCA off was the right thing to do but leaving a patient without pain meds for an extended period of time was not an acceptable alternative.

AMBOO · Nov 28, 2003

Originally posted by DoctorRN
AMBOO,

All hospitals have a chain of command to follow. When you attempted to call the physician and could not reach him you should have instituted your chain of command to help resolve the issue. This takes the legal monkey off your back and places it on someone in hospital admin. It becomes the administrations responsibility to contact either the physician caring for the patient or the cheif of staff for the service he is on.
In my experience, it only takes one call from the hospital administrator or the Chief of staff to get a lazy doc off their butt to care for the patient.
Turning the morphine PCA off was the right thing to do but leaving a patient without pain meds for an extended period of time was not an acceptable alternative.

Hi! I agree with your post but as you can see the reaction you get when you call "chain of command" at my hospital you are in trouble either way, so you learn to live without someone to back you up and unfortunatley my floor supervisor is finding out what her great management skills are doing... we have 1 staff nurse left...three new RN's came to our floor and NONE returned!!!! As for leaving the patient without pain meds for extended period of time...I would rather know what little airway wasn't comprimised remain patent than risk giving another rx and risk another rxn. As you saw in my post she has multiple allergies and hx of vent, tachs...etc Also, when there is no MD calling back I can't give anything till a order is given, but that was just my nursing judgement and there were multiple issues.

stevierae · Dec 6, 2003

Amboo, I think you did the right thing. These types of patients (with all her medical problems, she has probably been through many, many hospitalizations) know their way around the hospital system---how else would she have known to call the hospital supervisor? Also, airway was your top priority, as you stated--and with 36 allergies, what else could you have done but stop the MS and page the doctor for new orders? Was there anything relatively innocuous ordered thatyou could have given her p.o. or IM for pain--i.e., so as to at least defuse the situation temporarily? Even if it was just plain ol' Ibuprophen? Something that wouldn't have compromised her renal status? Heck, maybe you could have added an extra 25 mg. of Benadryl and put her to sleep for a while (but not if you had a set dosage for anaphylaxis that you couldn't increase.)

I agree with your husband. I hate working for supervisors like that, who think that they can come and go as they please according to family needs, never available for their staff. Get the he** out of there--not a fun or safe place to work.

Rapheal · Dec 6, 2003

I feel for you- I really do. Good call on d/c the PCA. This is what I would have done. Called nsg. supervisor explaining the situation of pain mgmt. not calling back. I then would have called primary doctor back and explained pain mgmt. not calling back. If no order I would have called nsg. supervisor again. And I might add the first time I would have called the nsg. supervisor he/she would have said "have you called again? Did you call the primary?" Then the second time I called them they would have acted all pissed off and told me to call again. Then when I called them a third time they would get angrier and I would be accused of not using my critical thinking skills. Then I would leave work wishing I had another job lined up.

Momma told me there would be days like this. You did the what you thought was right. And I know that while you were trying to take care of that situation- other patients needed your time and attention. Sometimes it just stinks like that. I hope tomorrow is better.