Donnagg123

We give IV vanco PO. The pharmacists swear it is cheaper to reconstitute and give PO than to give the PO pills.

see if you can change to a crushable form of something similar. My pharmacy usually recommends senna.

What about a patient that has dementia and management is saying this person "has to" get up for day on night shift as therapy supposedly does this resident 1st when it is very obvious the person does not want up on night shift. Don't they still have a right to refuse?

I know the answer but want opinions. What to do when a patient family is insistent that the person is in pain, yet the patient consistently denies pain and no symptoms of pain when family says resident is. Here is what happened. A patient who is hospice but still able to talk / make decisions etc. When one particular family member is there they are telling nursing that resident is in pain. Yet when patient is asked if in pain res denies it. Family says patient moans out, says resident tells them is hurting, hallucinates, and is awake off and on (while family sitting next to bed hovering over while patient sleeps), sits up and moans. NO ONE sees these "displays" of pain that they say they are seeing even when observing resident for long periods. When resident does actually have occasional complain of pain tylenol is effective. Yet particular family member is insistent that he needs morphine. What to do? I know there are times residents feel more comfortable telling family they are in pain versus nursing but we cannot force someone to take pain medication, right?

Thank you for that. :) She implied it was a law and she said "legally" and I was like ??? I did not think it was.

I did not mean to imply that you would never use nursing judgement to decide when to hold or not. I was just curious where she came up with the "3 dose" rule. If that was just a standard or some law I had never heard of. Of course if I held say colace because a resident was having diarrhea no I am not going to call an MD at NOC to tell him LOL But I agree with the others that if there is something in the vitals dramatic enough to warrant you holding meds like BP dropping etc then you need to get to the root cause...is there something more going on? I got the impression from the person that even still they felt it is okay to hold for 3 doses before notifying MD. Implying that I was overreacting. The person also believe that pretty much there is NO reason to call MD at NOC.

Even with parameters you can only hold so many days / doses then you have to notify md right?

In a discussion today it was brought up about holding meds. A nurse said legally you can hold 3 doses without notifying MD. I thought you have to let MD know asap if you are going to hold meds? Legally how many doses can a nurse hold (if there are no parameters) before notifying MD?

Besides passing midnocs meds (frequently) and 5-6 am meds lots of nebs sometimes accuchecks in the AM if they get no coverage. In the meantime finishing up everything 2nd did not get done in regards to processing orders and finishing admissions. Monthly summaries and medicare charting. Glucometer checks and checking temps on fridges. We get med deliery on 3rd. Doing change-over monthly. Dealing with all of the sundowners and bed alarms answering call lights taking everyone to the bathroom atleast 50xs. Other than that well (at least according to day shift) we do nothing....

I know this is old, but ...do you work where i work?? It sounds awfully familiar... LOL

Never assume things because it does not work that way where i work. For CII they have to have a copy or the original valid script or you are not allowed to get into the EDK. It is illegal. period. They used to be able to send us a 3 day supply without a script from back up. Not anymore since the rule change. I would NEVER intentionaly let someone suffer, but what are we supposed to do? Also, It is not like we give them NO pain meds but if they are to the point of needing a CII (which now includes all hydrocodones!) you are screwed with no valid script. Here they do not accept scripts from PA's either. We can do tramadol without a script but that is as far as it goes narc wise.

you are correct! so you don't know they do not have the script till too late. OR if someone has increased pain at noc (even for established residents) if you do not have a script you still cannot get into narc edk. So yeah these new rules may be helping to control abuse or whatever but it really hurts the ones who need it and can't get it and as a nurse to see a resident in pain and not be able to help is heartbeaking

I just need to vent. I am very frustrated with the new narcotic rules. The rule is now even Norco's we have to have a valid script and a code before getting into the E-box. Some may say well that is not unusual. BUT when you work nocs and new admits come in or a med is out.....it really ties your hands. You cannot get their pain meds etc so if they are hurting or cannot get their routine anxiety meds etc then the resident is punished and you may get in trouble for not controlling pain etc. Your damned if you do and damned if you dont. You may also say that the ones that have been here SHOULD had it already taken care of or the ones that come from hospital SHOULD have a valid script with them, but the sad fact (as those who work LTC know) this just does not happen. To me, THAT is what the E-Box is for! Maybe you might have to get a code etc, ok I understand. Nope, now they are saying if you do not have a valid script it is a NO and illegal. What are you supposed to do for your patients? Very frustrating....

how about "shortness of breathe" ..... it is shortness of breath!

How many people are you guys responsible to give the lax to and how many do you usually leave for her? Depending on how many I would say that she probably feels like you are doing it on purpose at 1300 so then she is responsible for the next step at beginning of her shift. Not saying you are but that might be why she is getting angry. You say your med pass ends at 10:30 is there any way you could stagger some of them out after that instead of waiting till 1300? But I also agree that it is a 24 hour facility so sometimes she will have to understand that some things will get passed on. JMHO Also i as well am surprised that Aides can give a fleets. I would think you would have to assess, what if it inadvertently triggers the vagus nerve?