Sunday, May 8, 2011

More on the Roxanol Question

When a resident is in a great deal of pain, the doctor will sometimes prescribe Roxanol. This is liquid morphine. It works fast, but it does not last very long, so we sometimes have instructions to give it every thirty minutes, as needed.

We have a debate every time this comes up. For some reason, no one wants to be the one to give that last dose of Roxanol before the resident dies. I don't get it and I don't have a problem with it. If I am giving it according to the doctor's orders and the Hospice Nurse and the Charge Nurse are aware of it, I'll be there with it when the resident needs it.

But, what if the resident doesn't want it?

The simple answer is not to give it. Yet, if they are curled up in the fetal position, refusing care, and crying because they are in so much pain, then what? Do we let them suffer, because that's what they want? Or do we cajole them into taking the pain medication, even though it may speed up their end? And, further more, if they let us give it, do we then keep them snowed to prevent them from hurting or do we wait until they are crying again before we give it?

Welcome to my position between the Scylla and Charybdis.

1 comment:

Hold my hand: a social worker's blog said...

Comfort care--that's the key. Keep the patient pain free. I can't stand seeing a patient crying and in misery. If they refuse meds and care, remember their mind may not be clear to understand what they are refusing. Or it may just a sign of "leave me alone" and the resident is most likely ready to meet the Lord.

So, Roxanol is a appropriate. Glad someone came up with the idea of liquid sublingual pain/anti-anxiety meds.