Primum non nocere

[guest974915]

I've been thinking lately about Medicine and Nursing's role in the current opioid crisis. Our new thinking regarding pain-i.e 'pain is the 5th vital sign', "pain is whatever the patient says it is".... Acting within this paradigm, have we really done more harm than good in our attempts to empower our patients and proactively treat this endemic problem or have we failed with an entitlement approach that has created widespread dependence and addiction? When nurses hands are tied to exercise clinical judgment and to safely and judiciously administer effective analgesia, have we really gone forward? When patient X displays no clinical indication of pain yet persist in his requests for Oxycodone that is ordered (although an equipotent non-narcotic alternative is available), are we as nurses anything different than a human Pyxis? Tough question

[Daisy4RN]

Yes this is a big problem and as usual JCAHO has not helped. I remember when this was first implemented, we all had concerns. No nursing or MD judgement allowed. Just medicate. As with many other nurses I have witnessed the abuse (from patients) of this thinking (some figure out real fast how to get those meds). We are certainly not doing them any favors by providing this service to them. I hope with all the new rules we dont swing back so far that we will be under medicating. Maybe JCAHO should have just provided Ed and left it alone (along with half of their other "suggestions")

https://www.physiciansweekly.com/the-opioid-epidemic-what-was-the-joint-commissions-role/

https://www.beckershospitalreview.com/opioids/7-things-to-know-about-the-history-of-the-joint-commission-pain-standards.html

[JBMmom, MSN, NP]

I think it's just one more aspect of the "customer service" focus of providing care that does more harm than good for care in general. We are no longer evaluated based on the outcomes of care, just satisfaction. Did we improve the patient's health to the point that they could go home? Who cares. We served them a cold meal? Didn't answer the call light in time? Didn't administer every requested medication? Unacceptable!! Trying to educate patients on pain management options that are non-narcotic is generally met with blank stares and refusal, so I think most providers just order the narcotics rather than get 42 calls from nurses with angry patients. It's not the best for patients, but unfortunately, it's just one symptom of a larger issue associated with the climate of patient care.

[CalicoKitty, BSN, MSN, RN]

When I give people pain medication, sometimes I try to ask them if it is legitimately helping their pain. In my experience (with a week of T3 from dental work!) sometimes the pain medicine doesn't even help, but you take it anyway because you think it's helping. I remember getting very angry when my dentist didn't give me a refill. In hindsight, I probably had a minor physical addiction. I took ibuprofen after, and life was beautiful.

Other times, if I have a post-surgical patient, typically 2nd day I see them, I discuss the importance of controlling pain along with the ease of physical addiction. I've read some articles that say it takes about 5 days or a week to start a physical opioid addiction, and others mentioning something like if a person is taking narcotics for a month will likely be taking them a year later.

I also offer the non-narcotics and ice packs, sometimes heat (we don't carry hot packs on the units, so there's a water warming thing instead).

In the end, after quick education, I get the patients what they request.

[Here.I.Stand, BSN, RN]

Except sometimes.... the pain IS what the pt says it is. Some people who live in constant chronic pain, or who are culturally molded to be stoic, may NOT “display clinical indication of pain.” Who am I to impose my judgment?

Personally I would rather feed Patient X’s addiction than cause Patient Y to suffer.

[ruby_jane, BSN, RN]

I think that like anything, we'd all be able to provide more competent care if we had more time. We do not. Education empowering people to ask for pain medication when their pain is, say, a five as opposed to when it's a 10 is also critical but how often does that get done? One day we may have some kind of spit test to tell us which pain relievers are efficacious for our genetic profile and which aren't...but until then, I guess we keep doing our best.

[Guest219794]

Pain is not a vital sign, and never has been,

Signs are, by definition, objective.

Pain is, by definition, subjective.

In my ER we are now less a part of the problem than we used to be. We used to regularly give narcotics to obvious drug abusers who were clearly lying, and we no longer do.