Too many narcs for the wrong reasons.

[MarcusKspn]

Hi all nurses out there,

This is my first post here. I am currently a Student Practical Nurse, but I have worked for a year as a Medication Aide in Long-Term Care. I was wondering if anybody else has come across situations where they felt that Narcotics were given for the wrong reasons. I have had two confrontations with other staff members about the use of narcotics.

The latest confrontation I have had was with a CNA on one of the halls where I was passing meds. We have a resident on that hall who has a habit of wandering, calling for nurses, she is confused and will call for you if she sees you walking by her room. Most of the time she will quiet down if you find out what her need is and take care of it. That evening the CNA came down the hall and told me that "She is getting on my nerves, she won't shut up. Give her an Ativan." I told her that she will calm down by herself if she finds out what she needed, but she got mad at me and run off. After that I walked down to the residents room to see if she really was as bad and restless as the CNA said and found her covered up in bed yelling "I want to be warm!!!". Her thermostat was set on 55! (for the CNA confort, not the residents) I turned up the thermostat, covered her up with an extra blanket. For the next 2 hours the resident was quiet without the use of Narcs.

My first confrontation was in a different Nursing home with an RN. We had a resident who after she was put to bed after supper would yell for help for about 30-45 minutes. If you asked her what she needed she doesn't even remember yelling we all had those kind before. One night the RN on duty was in a bad mood, has had a bad night, and was tired of listening to her yell. She told me to give her a Lortab 7.5/500 to get her to "shut up and go to sleep". I told the RN that the resident will go to sleep by herself in about 30 minutes, she doesn't need a Lortab. (the resident was also on Duragesic Patches, and her pain was being controlled, she would specifically ask for pain pills when she did hurt) The RN told be that she wanted her to have the Lortab and I better do as I was told. Pretty ticked of at the RN now, I opened up my MAR to the residents page, looked for the doctor's orders and told my RN that her doctor has prescriped "1 Lortap 7.5/500 q6hr prn Pain" not "1 Lortap 7.5/500 q6hr prn for staff convienience and chemical restraint" (yes I know, I was a mere CMA arguing with the BSN RN about her decision) and I told her if she wanted the resident to have it she will have to sign it out herself and give it to her, because I did not feel comfotable dispensing that narcotic under this situation. She ended up signing it out herself and giving it.

I wonder if any of you out there have had similar experiences and what you think about the use of narcotics for staff convinience.

Let me know what you think.

[fab4fan]

Meds should not be given to sedate the pt for staff convenience, period.

That being said, sometimes in the case of a confused pt, when all other measures have failed, and the pt is unable to communicate what is wrong, I have given pain meds, with the idea that perhaps the pt is in pain and just unable to express it.

And I have also given sedatives to agitated pts when all other measures have failed; it's funny how some of the most basic things get overlooked....maybe the pt just needs to go to the bathroom, or is cold, hungry, thirsty, etc.

Good for you for taking the time to actually assess the situation...which is what we are supposed to be doing, anyway.

[Glad2behere]

Agree with fab4fan, situations like this do occur, and they make me uncomfortable as well. Seems like if the resident yelling was a usual behavior of that resident that reached an irritation factor with the staff and other residents someone should have lobbied for prn sleep med. Were there not any standing orders for these?

7.5 Lortab is a little aggressive I think.

[ptnurse]

Good for you, standing up for your residents like that. Way to go. Great job assessing the situation.

[crazygirl]

Well, I agree with Fab4fan, there are times you need to use your best guess and with demented or confused patients "a pain pill is just what the doctor ordered" to help them settle down when they themselves might not have even noticed they are in pain. also ativan is great for anxious, demented patients when needed. but kudos to you to make sure all the needs and wants were met first before medicating. just don't become like some nurses i've worked with who will hold back narcotics at all costs, thinking they do not want to "over-medicate" there is and can be a "happy medium" :)

[RNConnieF]

We need more NAs like you. You know your patients, you use your knowlege to assess them, and you sitck by your assessment. We should all be so lucky as to work with you. Even more our patients should be as blessed as yours are to have you caring for them. Bless you.

[MarcusKspn]

Well, it's me again

I'm worried that I might have come across as a little of an "anti-narcotic". I believe in the use of narcotics if they are used proberly. I have had patients where I was the only aide controlling their behavior by controlling their pain (prn tylenol and occasional Lortab's), by giving the resident the prn narc I was able to keep him calm. (If his knees were hurting him he would get agressive). Since I left the unit the other staff has settled on keeping him druged up on Ativan BID routine. I have seen people finction as normal human beings when put on restoril, duragesic's and ativan. I have also stood up with other nurses to advocate morpine for an end stage cancer patient when the doctor was afraid he might become "addicted" in his last couple of months alive. I think narcotics are a great thing when used to enhance a patient quality of live. But I don't like to see them used to shut up a patient. I usually put it this way to new aides and some of the other staff. Our patients are paying to be here and to be comfortable. Us nurses are getting paid to be uncomfortable while making them comfortable

Thank you for all your replies.

[jude11142]

At the LTC where I work, I too, have seen other nurses givings pts meds to "quiet them". Ok, I can understand that ativan or xanax may be appropriate but to give tylenol#3 or percocet for the sole reason to "quiet a pt" is totally wrong!!! This one nurse when I get report from her always tells me, "give Mr. X a percocet at bedtime, because it knocks him out".............Can you believe it? Also where does she get off telling me what and when to give something like that? We must do the right thing for our patients, and not do the wrong thing so that the shift will be quiet. I am a new nurse and a new employee but I refuse to medicate any patient for convenience. This makes me soooooooooo mad!!! Just my opinion.

JUDE

[nimbex, RN]

Have to add, in your profession, with the elderly... narcotics usually work the WRONG WAY and cause restlessness and more confusion and more anxiety.

I hate giving sleeping pills to the elderly, Always ask for haldol with confusion (needing to settle to protect invasive lines) before ativan...ect.

However, I've had little old women in their 80's kick my butt and need to be mildly sedated before they hurt themselves as a last resort....

GREAT CALL... Don't get me wrong, in the ICU, a sedated, paralyzed vented patient isn't unusual....... as a last resort.

I hope your attitude and thoughts are catchy!!!

[MarcusKspn]

Thank you all for your replies, they made me feel a lot better about my additute about narcotics.

[nurs4kids]

Why is a NA giving narcotics in the first place?? Is that accepted practice in some states?

[Youda]

You're going to be an excellent nurse! Yes, narcs should be given AS ORDERED, that doesn't mean to give a narc when the room is too cold. You handled the RN situation well, by asking her to give it when you didn't feel that the resident needed it. Your head's on straight. Somewhere, somehow, someone has taught you well! Thank goodness you had those role models instead of those you work with. You are terrific!