Griff1950

Some newer studies have been done which indicate that it is better in some cases to change the patches more frequently than to increase the dosage. If the patient seems to be comfortable for the first day or two with the 50mcg. patch, then becomes uncomfortable on the 3rd day, I would see about decreasing duration between changes.

Our facility did not have a career ladder as such, so I manufactured one of my own. After much study on my own time, I drafted a pain management program and presented it to my DON. I was given room and time to run the program, which evolved into restraint management and fall prevention. It took lots of study offsite and on my own time, but was well worth the effort.

Sleepy, I don't mean to come off as hostile, it's just not acceptable procedure. And as for quitting jobs every 6 mos., I have done that too! My license means too much for me to lose it over some one else.

#1, I've never seen a situation where it's legal to "borrow" any meds from another resident, let alone narcs! #2, here in Arkansas, we have to have a 24 hr. backup pharmacy. In the case of a "surprise" admission, we have to have meds in the building within 2 hrs. of the arrival of the resident. #3, as for narcs in the DON's office, I wouldn't be working there!

Question re: Fentanyl patch? I assume you are changing the patch at the recommended 72 hr. intervals? If so, is there an association of this time period with breakthrough pain? There are some new studies of Fentanyl transdermal dosing that suggest a 48 hour interval works better than increasing dosage amounts.

Opiods have no ceiling dose.

As a pain management nurse in a LTCF, I would definitely adjust that nurse's attitude. She apparently needs to be in-serviced on pain and medication administration.

First, do no harm.

Blew a disc 2 weeks before I finished LPN school, went thru the pain and finished, then had lumbar laminectomy. Oh, yeah this was 1999 after having 5 bypasses in '92, and a gastric bypass in '97. Had the laminectomy as an outpatient and recovered in time to do my RN prereqs during summer sessions. Did the 11 month bridge program, had rotator cuff surgery while off for Thanksgiving holiday. Never missed a day of school. Now am sidelined from floor duty due to essential tremor, but work in a nursing home doing QA/QI, pain management, infection control and several other little things. Oh, yeah, now have 3 leaking valves, but no blockage, even 15 years downstream. EF of 25%, so I fatigue easily. But still won awards for pain management from Arkansas Foundation of Medical Care, and a letter of commendation from Arkansas Office of Long Term Care for restraint reduction. Our facility is now restraint free.

:balloons:I am a male RN, and was 48 when I started. Now 56, and can't imagine doing anything else. I manage a 70-bed nursing home on weekends, also do pain and restraint management, along with a few other duties.