Pain management

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This topic contains 7 replies, has 6 voices, and was last updated by Profile photo of Desiree Demick DesireeDemick 3 years, 6 months ago.

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    Profile photo of LisaRN

    I have a question…On the floors or facilities where you work is there a policy to determine how long after a PO med is given can a nurse give an IV or IM breakthrough pain med? I work on a floor where this subject is up for much debate and those who medicate a certain way (either refuse to give an IV or IM med within a certain time or do give an IV or IM med after a certain time) are often criticized by those who do it differently. When asked management always asks “whats the order say?” and the order just says for breakthrough pain and does not specify. These times management states it is up to the nurses discretion, which leads to very confused patients when one nurse will give a med within this time frame and another won’t. Our floor gives ALOT of narcotics, and pain control is a HUGE part of our care and effects our HCAHPS in a major way. We deal with a growing population of patients who have chronic pain and have had a long history with pain management so this is a very big discussion topic between our nurses who cannot seem to agree. Any comments would help thanks


    My opinion would be that if, upon re-assessment, pain is not controlled, it is time to use the breakthrough medication. So it would be based on your re-assessment time which should be between 30 to 60 minutes.


    I can see wanting to see if the pain pill is going to work or not, but we have no policy on not giving IV/IM meds on top of pain pills. If their pain was severe, I would probably go with the IV stuff instead of the pill and then give the pill once things were better under control, but if they need pain meds, I would give the pain meds as ordered. We give a ton of narcotics in the ER, so I have seen a few light weights stop breathing and stuff like that, so if they are frail and narcotic virgins, I start low and work my way up and use a continuous pulse oximeter on them, but for the doses I see written for the floor, they could have one of each and still not have any adverse reactions.

    Profile photo of Mary Ponesse

    I work in PACU so it’s a little different, but if you are giving the pain pills regularly and the IV/IM is ordered for breakthrough pain then it can be given at any time for breakthrough pain. I’m not sure what the discussion is about on your floor.

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