i am a new nurse half way through orientation and on the second day with a patient who has chronic pain found myself in a bit of a situation. overnight the pt's hr dropped to the upper 30's and 40's and was remaining there. with the full backing of my preceptor as well as the other nurse on the floor i did not administer the pt's prn oxycodone. i explained the reason why i wasn't giving the med to the pt in various ways several times but the med was still demanded. the pt states she wants to leave so ama paper work is brought to her. a hospitalist that is not treating the pt. explains the consequences of leaving ama and the pt decides to stay because the md said she could have the pain medication. (no new orders were written) hr is now at 38, clinical direction is notified who supports and confirms our decision to not administer the medication. long story short pt leaves ama.
would you have held the oxycodone? what other course of action could i have taken? is there a pain medication that i could have asked the hospitalist to write for that would not send us running with the code cart (that is still the "good stuff" the pt would have accepted)?
i just don't know....i have left the, question every step i make mind set and now am in the question 50% of what i do.
i'm sure anyone reading this can guess there is a ton of back story that i am leaving out.
Specializes in Cardiac,Progressive,Med-Surg,Hospice&Pal.
As much as we wanted to help our patient if themselves don't want help we cannot do anything fine AMA fine I gave you options I won't gamble the RN on my name just to pacify you.
leslie :-D
11,191 Posts
for a pt that is NOT opioid-naive and is otherwise 'stable', i would have likely given the oxy.
i don't see hr's affected by narcs frequently- if at all.
but i do understand those who wouldn't want to give it.
it really is a gray area.
leslie