Tuesday, March 24, 2009

A disturbing trend.....local or national?

I want everyone in the US who reads this to respond if possible.  In my hospital we are trying to find out if this is a trend in our hospital or something national.  So, please respond!!!

  Our hospitalists are giving out huge amounts of pain meds these days.  I remember when I started nursing (10 years ago) we gave out demerol (wow!) and morphine only.  To give diludid was a rarity and it was reserved for someone with chronic pain or someone in intense pain that demerol or morphine didn't work for.  These days demerol isn't used and morphine is even going by the wayside except for cardiac patients.

  For our chronic pain patients and really everyone we are giving out diludid like it is candy.  For those that come in with acute pain they will get anywhere from 0.5-2 mg IV q 4-6 hours depending on their age & size, etc.  But for those that are our chronic pain patients we are giving anywhere from 2-8 mg IV q 2-4 hours!!!!  Yes that's right we sometimes are giving 8mg of IV diludid q3h!!  That's enough to kill an elephant!  But the patient that was getting it last week was complaining that it wasn't enough!  What???

  This is becoming disturbing to us nurses and we were talking about it the other day.  We are surprised about several things: 1) the doctors are ordering doses this high, 2) the pharmacists are allowing us to administer doses this high and 3) patients are tolerating doses this high without complications.  

  So my question for those out there reading this is........

Is this happening out there or just here?


Rocky Mountain Mommy said...

It is happening everywhere. However in my hospital we still use demerol especially in L & D. But you're right...the patients are being given pain meds like nobody's business. I think a lot of it stems from where we are in society right now. People are broke, unhappy and even if they aren't having 10+ pain, they will say they are to dull whatever else is going on in their lives. I work with one doctor who luckily told one patient "Tell me why you are so upset, is something else going on" He got the guy to reveal what else was going on, instead of giving him diludid and sending him on his way.

adhdrn said...

I'm not seeing this trend yet, but I work in CICU where Morphine is our drug of choice. When I was on med-surge 1 1/2 years ago I saw quite a few orders for Tordol if Morphine wasn't effective. I am not seeing as much of that these days, occasionally I see orders for dilaudid but rarely for demorol.

Kim said...

It's happening on the west coast.

Big time.

It's almost like the Dilaudid is watered down.

Back in the day we used it rarely and 0.5 mg would knock someone for a loop. Now, it's like water.

Prairie Clover said...

We are seeing that trend here in the midwest. Not the high doses you talked about but the increasing use of Dilaudid, especially for the PCA machines. I feel the reason that hospitalists and other doctors are ordering so much pain medicine is the growing trend that a patient is to be totally pain free so the hospital can get excellent patient satisfaction results. We don't use Demerol anymore but do use Morphine a lot. I think the Morphine is more effective than the Dilaudid especially if used with an occasional dose of Toradol!

D'Vorah said...

I work in Oncology, and we give a lot of pain medication, primarliy morphine. I think that the trend is to treat pain as a serious issue -- there is plenty of research that shows that untreated and undertreated pain has a negative effect on health and healing.

Lisa said...

Multiple teachers/RNs have mentioned this over the past year during my nursing classes- that seemingly over time everyone is becoming more and more numb to medications, they're becoming stronger, and doctors are willing to let them go more easily. I think this is definitely a societal trend.

SAM Boston said...

I work at a large teaching hospital in Boston, on an acute med/surge/trauma floor. We start with the morphine/oxy (15) cocktail and if that doesn't work we go to dilaudid iv alternating with po. I've had orders 4-8mg q 3hrs prn. We are always cautious to give such large doses, espically when we don't know the patient or what they can handle...I always just make sure there is a narcan order on hand whenever it's this large.

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