undermedicating pain in the elderly

SRbear · Sep 21, 2004

One must be careful to medicate a pt. for pain that has not been medicated prior. It could look like you are giving them pain meds just so you can take it.. just a bit off topic..but so closely related. As a charge nurse, I make rounds, ask people about their pain, and medicate them if they request it....sometimes with a confused person..it is a judgement call, you need to consider the diagnosis, and would this person usually have pain with this...if confused pt. is agitated, restless..pain could be the cause. I was recently fired because another nurse said that I medicated her patient, and she ( the nurse) did not feel the patient needed pain med. There has been a gigantic push to treat pain as the fifth vital sign, and that pain is what the pt. says it is...not what the nurse thinks it is.. Well the powers that be looked at the pain meds I had given, decided I gave much more as compared to 2 other charge nurses.....so of course I must be taking them.......urine test- negative.. but I did wait for almost 2 hours before getting to outside lab...I was so upset, spent the time in my car, crying, and being so mad I could not see. Well.. since they were so sure I had taken them, but since I had waited 2 hours, they figured I some how messed with the urine test, and fired me for intervering with an investigation. So..back to main topic..even though pain treatment is being pushed...be very careful.. it seems still that under-medicating is preferred...just watch yourselves.

old rural nurse, RN · Sep 21, 2004

SRBear, I think it's terrible, what happened to you. Do your supervisors not realize that pain can be at it's worst in the evening or night when people are trying to rest and have nothing else to think about? I work with one nurse in LTC who thinks a couple residents we have who watch the clock are just out for the drugs, and doesn't believe they need that much pain med. These are a couple of sane, younger (

UM Review RN, ASN, RN · Sep 21, 2004

I work with one nurse in LTC who thinks a couple residents we have who watch the clock are just out for the drugs, and doesn't believe they need that much pain med. These are a couple of sane, younger (

Yep.

By all means, I would not hesitate to try to address this issue with the patient's doc.

Just report what you're seeing, and also you can add that other staffers seem to think that these patients are "clock-watchers," but studies have shown that "clock-watchers" frequently do have the pain they c/o, which is the basis for your concern that they may need an increase in pain medication.

Maybe it's time to up the dose, increase the frequency, or add something that will help them more but not get them snowed completely. Or maybe if it's chronic pain, it might be time for a pain management consultation?

I usually have no problem getting orders for this type of situation, and what surprises me most is, the doctors actually seem to expect that call.

anndoodle · Sep 22, 2004

One must be careful to medicate a pt. for pain that has not been medicated prior. It could look like you are giving them pain meds just so you can take it.. just a bit off topic..but so closely related. As a charge nurse, I make rounds, ask people about their pain, and medicate them if they request it....sometimes with a confused person..it is a judgement call, you need to consider the diagnosis, and would this person usually have pain with this...if confused pt. is agitated, restless..pain could be the cause. I was recently fired because another nurse said that I medicated her patient, and she ( the nurse) did not feel the patient needed pain med. There has been a gigantic push to treat pain as the fifth vital sign, and that pain is what the pt. says it is...not what the nurse thinks it is.. Well the powers that be looked at the pain meds I had given, decided I gave much more as compared to 2 other charge nurses.....so of course I must be taking them.......urine test- negative.. but I did wait for almost 2 hours before getting to outside lab...I was so upset, spent the time in my car, crying, and being so mad I could not see. Well.. since they were so sure I had taken them, but since I had waited 2 hours, they figured I some how messed with the urine test, and fired me for intervering with an investigation. So..back to main topic..even though pain treatment is being pushed...be very careful.. it seems still that under-medicating is preferred...just watch yourselves.

That's precisely why I always have the CNA's who are working with me know what resident I am giving pain meds to and when. Many times, I even have the cna to come in the room with me and witness the resident actually taking the medicine. This way, I have "witnesses" as to the resident actually moaning, screaming out, crying out, in pain....and I'm not just making it up. I'm not going to let my residents lay there in pain, but I value my nursing license enough to document everything thoroughly and completely. And the cna's will gladly inform them who was in pain and received medication, if asked.

apaisRN, RN, CRNA · Sep 24, 2004

One must be careful to medicate a pt. for pain that has not been medicated prior. It could look like you are giving them pain meds just so you can take it.. just a bit off topic..but so closely related. As a charge nurse, I make rounds, ask people about their pain, and medicate them if they request it....sometimes with a confused person..it is a judgement call, you need to consider the diagnosis, and would this person usually have pain with this...if confused pt. is agitated, restless..pain could be the cause. I was recently fired because another nurse said that I medicated her patient, and she ( the nurse) did not feel the patient needed pain med. There has been a gigantic push to treat pain as the fifth vital sign, and that pain is what the pt. says it is...not what the nurse thinks it is.. Well the powers that be looked at the pain meds I had given, decided I gave much more as compared to 2 other charge nurses.....so of course I must be taking them.......urine test- negative.. but I did wait for almost 2 hours before getting to outside lab...I was so upset, spent the time in my car, crying, and being so mad I could not see. Well.. since they were so sure I had taken them, but since I had waited 2 hours, they figured I some how messed with the urine test, and fired me for intervering with an investigation. So..back to main topic..even though pain treatment is being pushed...be very careful.. it seems still that under-medicating is preferred...just watch yourselves.

You could probably sue. They have no grounds whatsoever. I don't know about the investigation part though, were you instructed to go to the lab immediately?

I work in ICU where nurses give pain meds like water . . . sometimes more generously than ordered . . . I can't imagine working LTC with nurses who don't care about patients' pain. What's the down side of giving a Lorcet? The patient sleeps all night? Geez, that's a serious side effect.

nancynurz · Sep 24, 2004

The longer you stay in the hospital, the more risk you have for noscomial infections. Plus, I know I just plain feel better in my own home and on my own schedule with my own food :)