What??

[Crusades]

I have a resident with an order for T3. It is;  1 to 2 tabs every 4 hrs as needed for pain. This resident has cancer (in treatment), above knee amputation rt leg, with phantom pain and bone spurs. And Recently 1 of his toes amputated. DX PVD, neuropathy.... Most of the health problems this resident has is due to poor life choices. Smoking, drinking etc. 

My "managers" and some co-nurses have decided that they don't like how much the res is taking and instructed us to only give 1 T3 instead of 2. However this res is not opiate naive and 2 tabs have only made the pain tolerable.  As you can imagine, pain is not managed with 1 and is in pain for most of the day in which the res has increased his alcohol consumption.  There is a marked attitude regarding this res because the poor choices that have led to his health conditions.  

I advocated for this res and they said wait 30 min and then give a 2nd tab however, this is obviously not written on the order. They say because the order gives a dose range you can give the 2nd tab in 30 min if you only gave 1. I'm like no, that isn't the frequency written on the order. 

As well, another nurse only gives him 1 regardless of his pain level and because she only gives 1 apparently all the other nurses should only give 1 too. I'm like I'll give the appropriate dose within the order depending on the pain level and the needs of the resident not "what the other nurse did". And I most certainly will not "give another tab " in 30 min unless the order states that. 

I feel like I am being gaslight. 

[Rose_Queen, BSN, MSN, RN]

Many facilities have done away with range orders, in favor of parameters based on pain level; ie, give x dose for pain less than/equal to 5, give xx dose for pain greater. Order should be clarified.

[Crusades]

Rose_Queen said:

Many facilities have done away with range orders, in favor of parameters based on pain level; ie, give x dose for pain less than/equal to 5, give xx dose for pain greater. Order should be clarified.

Yes. It seems to be a grey area and facilities have various policies.  However apparently it's not set in stone as I believed.  Thank you for your reply. 

[midnighter94, ADN]

According to JCAHO, you can give 1 tablet or 2 tablets every 4 hours, BUT not both...you can't give 1 tablet then give another 1 tablet.  If you give 1 tablet, you then have to wait the full 4 hours before the next dose.  They actually don't want orders to have a range on them, they'd rather the dose be specific (1 tablet or 2 tablets, but not up to the nurse to decide).

I would talk to the doctor and have the order changed to 2 tablets every 4 hours.  Also, is there any other medications being given?  Robaxin?  Something non-narcotic?

[Nurse Beth, MSN]

As the above posters said, ask the doctor to change to a non-range order. The patient's pain will be better controlled, and it will eliminate the other nurses' biased practice.

[beachynurse, ASN, BSN]

This subject is a very sore one for me.. I understand the concerns about opioid use, however, that pendulum has swung too far in the wrong direction and patient care is suffering. How do I know? I'm one of those people with horrible pain and no treatment other than OTC meds which do nothing. 
 

I had 2 back surgeries 2 years ago and I am in worse shape than before the surgeries. The pain is constant and excruciating most of the time. I can't walk more than 15-20 ft without crutches, and can't stand long enough to even prepare a meal. I can't sleep in my bed, but can only sleep in a chair in my room. I have been to 3 pain management offices, and all they do is inject my back which is helpless. I have never experienced what I consider to be medical neglect by every physician I have seen. I've had md's tell me I am a good candidate for low dosage pain meds.. yet no one wants to prescribe anything. Our health care system is failing us. 
 

Someone needs to speak out, and do something. Chronic pain is real, and often untreated, or not treated properly. I just want to have some quality of life. Is that too much to ask. 

[C.Love, MSN, NP]

He needs a bette medication, T3 is too light there are much better options out there. Perhaps he needs palliative care team to manage his symptoms. This is poor pain management and the nurses and managers aren't the ones to decide and prescribe how to give patient's meds. It needs to come from the MD, NP or PA. 

beachynurse said:

This subject is a very sore one for me.. I understand the concerns about opioid use, however, that pendulum has swung too far in the wrong direction and patient care is suffering. How do I know? I'm one of those people with horrible pain and no treatment other than OTC meds which do nothing. 
 

I had 2 back surgeries 2 years ago and I am in worse shape than before the surgeries. The pain is constant and excruciating most of the time. I can't walk more than 15-20 ft without crutches, and can't stand long enough to even prepare a meal. I can't sleep in my bed, but can only sleep in a chair in my room. I have been to 3 pain management offices, and all they do is inject my back which is helpless. I have never experienced what I consider to be medical neglect by every physician I have seen. I've had md's tell me I am a good candidate for low dosage pain meds.. yet no one wants to prescribe anything. Our health care system is failing us. 
 

Someone needs to speak out, and do something. Chronic pain is real, and often untreated, or not treated properly. I just want to have some quality of life. Is that too much to ask. 

Exactly!

I'm so sorry you are going through this. I hear this scenario so many times. Keep searching for the right doctor to help you.