Bear with me for this is going to be a little long. I was covering part of a shift for a co-worker on my scheduled day off. The shift was 7am-730pm and I was working 9 to 3:30 for her on the regular med-surg floor(I work Neuro med-surg normally).
I came in and my co-worker gave me report on her patients and then she left. She told me she did everyone's vitals and morning meds so everyone was set that the only thing she asked me to do was to give her sickle cell patient her PRN morphine. So I went in and accessed the patient and the poor girl was clenching the side of the rails squeezing her eyes shut she was obviously hurting. She was admitted for pain control and dehydration. She had orders for morphine 6mgs IV q2hr. Oxycontin 40mgs q8hrs, ativan 2mgs IV q6hr she also had prns for benadryl and zofran forgot the dosages though..probably 25mgs and 4mgs respectively. So I went in and gave her the morphine and she said it hasnt been working and the other nurse was supposed to get an order for something else. The other nurse made no mention of this to me so I called her doctor.
I spoke to the resident and he was open to my suggestions so I suggested this patient would be a good candidate for a PCA since she was requiring PRNs Q2 and wasn't getting much relief from that I thought a PCA would be good for this patient. Not to mention most sicklers I get on my floor are on a PCA and do well. So I got an order for a fentanyl PCA and the doctor also ordered toradol 30 IV q6 and a one time dose of IVP fentanyl 50mcgs to break the pain she was in since the morphine didnt help and to hold her while I was setting up the PCA. So I gave her the fentanyl and toradol and just after that she said she was feeling a bit better. I gave her the PCA and about an hour and 15 minutes after I set it up for her she was up and sitting in a chair watching TV and drinking cranberry juice where before she was clenching the rails looking(and feeling I am sure) like death warmed over. She was smiling and thanked me and reported her pain down to 3 when it was a 9 before.
Now this is where the trouble started. My co-worker came back shortly after 3:00 to finish the rest of her shift. I gave her report and of course told her about her sickle cell patient how the morphine wasn't working and how I got her a PCA. My co-worker went ballistic on me. She told me this patient was a known drug seeker and scammer how she comes in the hospital all the time for narcotics and 3 hots and a cot and she was going to do everything in her power to get the PCA d/c because she wasn't going to cater to this addict when she had other patients with real problems to deal with. She was also mad that I didn't call her and consult with her about getting HER patients meds changed. I was just covering I should have just followed the med orders and she would be the one calling for order changes not me.
Am I losing it or am I really in the wrong here? This patient was obviously in genuine pain and with a sickle cell diagnosis I would rather treat faked pain then not treat potentially real pain. Also she didn't say one word about this patient being a seeker. She actually asked me to give her patient the morphine. I dont think anything is wrong with calling and getting a patients order changed that was visibly in distress. Its not like I was covering a lunch break. According to this nurse I should have made this poor patient wait 5 plus hours in excruciating pain for her to get back. I also didnt see any drug seeking red flags. She wasn't asking for any of the double D medications(demerol or dilaudid) she wasn't reporting 10 out of 10 pain while laughing on her phone and scarfing down trays of food and her HR was 110..she was in pain.
What would you have done? Would you have waited for your co-worker to get back or would you have called for a different order?
