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.