Wednesday, August 14, 2013

You Tell The Tale: Pain Med Grievance

Pain is whatever the patient says it is, but how far is too far and how much is too much?  Would you give undiluted morphine and push it fast because your patient insisted, or is there more to the story?  Should the nurse be more “by the book” or administer the medication exactly as her veteran patient requested?  

How it works:

Nurseables will start with a fictional account of a difficult nursing situation to get the discussion going.  Then, you write a comment about how you think the tale should end.  Anyone is welcome to write in, even if you don’t have a nursing background.  So write a comment, tell us your thoughts, play the role of the granddaughter, the patient, management, the nurse or a fellow coworker.  Get creative, have fun and let’s learn from each other!

Just a couple of rules to keep in mind:

1. Be cognizant of HIPPA, do not give any identifying information away in your discussion
2. Be kind and courteous in your responses

(Disclaimer: This is an entirely fictitious situation and any similarity to the characters or patients is completely coincidental.)

As always, looking forward to hearing your thoughts, comments, and creativity!

          “Alrighty then, those labs are looking good, so I shouldn’t have a problem giving the Lasix to Mr. Parker as long as his blood pressure…”  

Ding, ding, ding! rang out a call light down the hall. Disturbed out of her thoughts, Nurse Newbie looked up to see who was asking for help.  Sure enough, the call was coming from exactly where she had expected.  “Ah, right on time.  I swear, she’s gotta have an alarm set or something because that woman’s like clockwork!” she whispered to herself.  Caught up as she was in the beginning of the shift hustle, the interruption wasn't exactly welcome but she was there to take the best possible care she could of the patients in her charge.  Quickly saving her work, she made her way down to check on the situation.

“Yes Mrs. Jenkins, how can I help you?”  she inquired as she walked into the room, visually checking around to make sure everything was in order.

“Oh hello there Nurse Newbie, can I have my pain medication now?  It’s due in 5 minutes so I want to make sure you’re aware that I want it,” Mrs. Jenkins kindly requested.  In report, Nurse Newbie had understood that the sweet woman in front of her came in frequently with COPD exacerbation, but that she had terrible back pain.  She’d been told that Mrs. Jenkins always wanted her pain medication on the dot or else she threw a horrible fit, but…she didn't seem like that kind of person.  Maybe people just didn’t understand the pain she was going through or she’d just learned she had to be firm in order to get any relief…  Either way, she’d been told in nursing school that pain was whatever the patient said it was and that was the advice she’d go with because going with the flow just made life easier for both of them.

“Absolutely, I’ll go prepare it right now and be back in a jiffy.”  After a few probing questions to learn the extent of the pain and a quick look at the heplocked IV in Mrs. Jenkins’s left hand, she was off to prepare the dose. 

Now, being a relatively nurse on the floor, Nurse Newbie wanted to make extra sure that she didn't put her patients in harm’s way or put her hard-earned RN license on the line, so she double checked trusty Drug Guide from nursing school and prepared the dose accordingly.

Somehow skating by without interruption, Nurse Newbie promptly returned back to Mrs. Jenkins’s side with the 4mg of morphine the doctor had ordered, diluted to the concentration her drug book had indicated.  However, when she returned, Mrs. Jenkins started to dictate how things should be done for her to feel the full effect of the medication.  Unfortunately, all that she said went right in the face of all that Nurse Newbie had been taught and read in her drug book!  Push it fast.  Keep it undiluted.  Follow it quickly by a chaser of two full syringes of normal saline flushes…. and whatever you do, don’t you dare check my blood pressure first, I've been bothered enough as it is!

“Umm… Mrs. Jenkins, I hate to disappoint you, but I don’t feel comfortable with that because that’s not going to be safe for you…” Nurse Newbie tentatively replied.

“Oh, you don’t want to take care of me?!  Fine!! CHARGE NURSE!!  Get the doctor in here now to write an order about how I have to have my pain medication!!!”

What do you think?  Do you have any advice for Nurse Newbie?  What would you do?  Have you ever been a patient or family member in this kind of situation?  Is there another side to the story?  Leave your opinion or finish the tale in the comments below!

1 comment:

  1. Here's a taste of the great discussion on the Nurseables Google+ page!

    Jesse Casias
    I would recommend a much more comprehensive pain assessment PQRST. Also I would recommend checking the hospital policy and procedures prior to administering the morphine IV push. That would dictate my practice and always notify your charge nurse.

    Laura Westergard
    Always do the right thing… For all the obvious reasons.

    Rachel Mason
    I do as I have been trained and per my facility policy. If my patient is not satisfied with the protocol I encourage them to discuss options with their physician. Always do a thorough pain assessment (PQRST) and document!


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