April 13, 2015 at 2:01 PM #58754
I have been reprimanded a couple of times now because I refuse to give certain pts IV morphine. I used my nursing judgement and explained to the pts the reasons why they could not receive the morphine, ie vitals would not tolerate it or the fact that they will be discharged in the AM. At the hospital I am at there are a lot of drug seeking patients and will use the chest pain card to get their morphine. I do not understand where nursing or the medical field for that matter, has gone wrong. I have even been told by other nurses that they just give it to the pts to shut them up. Why are we enabling these people? When did we stop be educators and caregivers and become narcotic dealers?
My question to you all is how do you handle this in your hospital? I would appreciate any advice.
Thank youApril 13, 2015 at 7:30 PM #58776
Jason Hautala RNMember
If you think they are narcotic seeking, you should bring that up with the MD and have him write for some other medicine. If he wants them to get the morphine for pain control, then you should give morphine for pain control. Holding a medicine because vitals are outside the stable range is reasonable, but if they are, you should be doing something to address that issue, such as getting an order for a fluid bolus. Not giving them morphine because they are going to be discharged doesn’t make any sense to me. If they have been getting routine morphine and have remained stable, then there shouldn’t be a problem giving another dose before the discharge process. I would be hesitant to give morphine to an old, fragile, narcotic virgin as they are walking out of the hospital, but not giving them morphine in the middle of the night because they will be discharged in the morning doesn’t really seem valid.
I work in an ER so I can relate to your frustration about narcotic seeking behavior, but the pain contract and pain plan of care is between the MD and the patient. If you have a problem with it, take it up with the MD, but if the MD writes they can have it every four hours, it isn’t really your job to put them into withdrawals before they get discharged.
It frustrates me to no end to have a nursing home send a patient over to the ER for pain control, when they already have pain meds ordered, but they weren’t given because the nurse didn’t want to have to re=assess vitals and pain and everything after giving the medicine, so they send them to us to control their pain.
A well written PRN order is a wonderful thing and should have parameters associated with it. If you have two PRN orders for pain, you can use your nursing judgement and decide which one would be best to do first, but if the patient complains of pain and you have a PRN order for a pain medicine, you should either be giving it or calling the doctor and addressing the issue that makes you uncomfortable in giving it at that time.
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