What??

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. 

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?

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. 

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. 

Give what is charted by the doctor in accordance to your nursing assessment. If something went wrong or this patient complains your 'colleages' will throw you under the bus. 

Not to mention when pain isn't well controlled, people will medicate with other options. I recall as a student I had a patient with arterial ulcers in his lower legs, One nurse said one day "oh but hes an alcoholic' I pulled the 'it would be great practice for me' to ensure the patient got adequate pain relief. The patient spent most of the day hunched up and in bed. An angiogram revealed that the patient had almost complete blockage of the aorta with colateral circulation that had grown around the blockage. When the patient got on regular pain relief, he was relaxed, sitting up in bed and reading.