Roxanol use in ltc

leslie :-D · Aug 19, 2004

roxanol is perfectly appropriate and suitable for its' particular indications.

you need to look up your nurse practice act in fla.

but if a patient is receiving the hospice benefit, then roxanol would be appropriate to use, to help with a patient's labored respirations.

there is more liability if you let a patient suffer.

leslie

momcats3 · Aug 19, 2004

Why don't you ask the SW in your facility to contact whichever hospice they recommend and have them come in and do some pain management education with the staff? I've found these sessions presented by our Medical Director at our hospice go a long way towards educating some of the staff we deal with. It also takens the burden off you...

aimeee, BSN, RN · Aug 21, 2004

Main Teaching Points:
1. Many physicians inaccurately believe that morphine has an unusually or unacceptably high risk of an adverse event that may cause death, particularly when the patient is frail or close to the end of his or her life. In fact, morphine-related toxicity will be evident in sequential development of drowsiness, confusion and loss of consciousness before his respiratory drive is significantly compromised.
2. Many physicians inappropriately call this risk of a potentially adverse event, a double effect, when it is in fact a secondary, unintended consequence. The principle of double effect refers to the ethical construct where a physician uses a treatment, or gives medication, for an ethical intended effect where the potential outcome is good (e.g., relief of a symptom), knowing that there will certainly be an undesired secondary effect (such as death). An example might be the separation of Siamese twins knowing that one twin will die so that the other will live. Although this principle of "double effect" is commonly cited with morphine, in fact, it does not apply, as the secondary adverse consequences are unlikely.
3. When offering a therapy, it is the intent in offering a treatment that dictates whether it is ethical medical practice:
a. if the intent in offering a treatment is desirable or helpful to the patient and the potential outcome good (such as relief of pain), but a potentially adverse secondary effect is undesired and the potential outcome bad (such as death), then the treatment is considered ethical
b. If the intent is not desirable or will harm the patient and the potential outcome bad, the treatment is considered unethical
4. All medical treatments have both intended effects and the risk of unintended, potentially adverse, secondary consequences, including death. Some examples are TPN, chemotherapy, surgery, amiodarone, etc.
5. Assisted suicide and Euthanasia are not examples of "double effect." The intent in offering the treatment is to end the patient's life.
6. If the intent in morphine in the scenario is to relieve pain and not to cause death, and accepted dosing guidelines are followed:
a. the treatment is considered ethical
b. the risk of a potentially dangerous adverse secondary effects is minimal
c. the risk of respiratory depression is vastly over-estimated.
Reference: Emanuel LL, von Gunten CF, Ferris FD. (1999) The Education for Physicians on End-of-Life Care (EPEC) curriculum. American Medical Association, Chicago.
Fast Facts and Concepts are developed and distributed as part of the National Internal Medicine Residency End-of-Life Education project, funded by the Robert Wood Johnson Foundation.
Copyright Notice: Users are free to download and distribute Fast Facts for educational purposes only. Citation for referencing: Weissman, D. Fast Fact and Concepts #08: Morphine and Hastened Death. June, 2000. End-of-Life Physician Education Resource Center http://www.eperc.mcw.edu.

and

Studies by Dr. Brescia at Calvary Hospital in New York City show that there is no correlation between the dose of opioids a patient receives in the last weeks of life and the timing of their death. Studies of dying patients who were being withdrawn from respiratory support demonstrate that those patients who received morphine lived longer than those who did not receive morphine. Studies recently published from a series of British hospices show no difference in the time to death between those patients who were sedated to control their symptoms as compared to those patients who were not sedated. Finally, the doses of opioids that are often used to treat patients at the end of life are highly variable. The great majority of dying patients are receiving doses in a range equivalent to what you or I might receive as part of postoperative pain management and these doses are safe and effective."

source: http://judiciary.senate.gov/oldsite/42520kf.htm

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