The Roxanol Question

Yes, it's a two post day.

I accept the fact that the longer I am in the nursing center, the more people I take care of will pass away.

I accept the fact that my residents who are under hospice care are not going to get better and that their last few days may be fraught with pain and anxiety.

I accept the fact that medicating my residents to the full extent allowed by their doctor is part of the deal and that it may hasten the end for them.

So tell me why I have nurses who will not authorize the use of Roxanol to ease my dying resident's pain and anxiety?

The doctor's aren't stupid. They know what Roxanol is. They know that while it eases the resident's pain, it also slows down the breathing and heart rate and that this may push the resident over the edge into death. They know all this and yet they have still prescribed it.

Ya know why? Because the resident's condition warrants it.

Still the charge nurses don't want to authorize its use. The resident is in pain. We have this drug that will work almost immediately to ease the pain. But let's not use it. Let's use something else that takes longer and doesn't work as well because we don't want to be the one who authorized their last dose of anything, ever.

Not me. I say give it to them. By the time the doctor gives us a prescription for this stuff, the resident only has days to live. (Actually, I had one resident who used it long term, but that's been one out of well over one hundred residents that I've worked with.) Let's keep them comfortable. Reducing their suffering also reduces the family's suffering and anxiety. And if their life is shortened by a few hours or days, so be it. They weren't going to be up and dancing jigs in the hall anyway.

For me it never has been a question. Keep the resident comfortable by every means we have available. Anything else is unconscionable as far as I'm concerned.