How Long Is Your Loved One Left In Pain?

The time is 2:15pm. The patient begun to complain of pain. His pain level is a 5 out of 10. The charge nurse is requested to medicate the patient for pain. The charge nurse(CN) says that she will tell the Medication Aide(CMA) that the patient needs to be medicated for pain, but is busy at the moment and will let her know when she comes back. So you’re thinking that the CMA is busy medicating someone, and in good faith you’re thinking that the CN is going to have the CMA medicate your loved one when she comes out of the room of another patient.

It’s now 2:30pm. You go back to the nurse’s station to find out why your loved one isn’t medicated yet for pain, who is still suffering pain. The the CN tell’s you that the CMA is out on a 30 minute break and she will have her to medicate the patient as soon as she gets back.

So as smart as you are, you asked the CN, “Don’t you have a backup for when someone needs medicated for breakthrough pain?” She then replies,”No we don’t. The CMA is responsible for medicating the patient.” The CMA returns and the patient is finally medicated for pain at 2:50pm. That patient had a 35 minute wait to get medicated for pain in a long-term care facility when the medication is on hand is ridiculous to say the least. People this goes on in many nursing homes not just here in Houston, Texas, but in other states to I hear. What is wrong with this picture.

I have been in a nursing home that when the CMA is out on lunch break, then the CN would medicate the patient..The problem, I’m told, is fear of liability. The CMA’s do drug counts at shift change and are responsible for dispensing medications to the patient. So, if the count is off, no one can blame the CN. In some nursing homes the CN is in control of giving narcotics, and benzodiazepines such as Lorazepam, etc. Acetaminophen suppositories are generally in common stock.

I’m almost certain if that health care worker’s loved one was in that bed suffering s/he would have found a way of getting him or her medicated to relieve the pain. I’m sure that if that nurse or CMA was lying in that bed in pain would have been ranting, and raving about not getting pain relief medicine promptly.

You should report this concern to the Director of Nursing, Associate Director of Nursing, or the Administrator as soon as possible. The administrator could possibly influence policy. They may not be in if it’s after business hours. You can also report it to the Ombudsman’s office which has a phone number usually posted on the wall somewhere near the administrative office or on the wall at the ends of the hallways. If this is a concern for you in your state where there are vagueness of law concerning such intervention, you can also contact your state representative to see about having something done by law to make sure a patient is covered for getting pain relief. Remember pain is emotional as well as physical., and spiritual.

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Observations On Difficulty Swallowing (Dysphagia)

This article is about my observations on difficulty swallowing (dysphagia) a tablet(pill) or caplet in the terminally ill.  I hope that this will be helpful to both the caregiver(s), practitioners, and anyone else who wants to know. First make sure that the medicine not called slow release, sustained release, or enteric coated, because those forms are not meant to be crushed, pulverized, or broken.

My patient was at the point of not being able to swallow Lorazepam 1mg tablet. So, the Doctor was contacted who in turn had the equivalent ordered as liquid Lorazepam. The kind that I usually see is a 2mg per 1 mL concentration.

Before outright discontinuing that tablet, I would suggest requesting that the order would be to discontinue the tablet form of the medicine when the liquid one arrives. This is especially useful when the patient is in a nursing home, because some tend to get rid of the previous medicine quickly then the patient is left without anything, possibly for several hours.

I know in some instances the tablet form of the medicine isn’t disposed of yet, especially in the home, which I think is a good backup in case the liquid runs out before a refill has been made. This is when you can use a pill crusher, or place the pill in a large spoon, then press and rotate the small spoon on the pill to crush it. Next, place the crushed content in a small medicine cup, draw up 1/2 to 1CC or 0.5 to ! ML of water and place it into the crushed medicine, then stir to dissolve. You can stir it in the big spoon or in the medicine cup, or something similar. After you draw up the medicine with the syringe(No needle), you can drizzle it under the tongue for Sublingual(SL) administration or between the cheek and gum line if ordered as such. As nurses we communicate with the prescribing practitioner to get an order for the best route for the patient for palliation. Sometimes the rectal route(PR) or topical(usually gel, cream, or patch) to the skin is done. Some use subdermal (under skin) route. Many avoid I.V. the route due to added pain in the process of starting one, but on some occasions may be necessary

Please don’t fill a medicine cup with water or juice to dissolve medicines in, and think that that patient is going to swallow 15 mL of that concoction without choking, or worse, aspiration.

One day in humour, I heard a nurse say, ‘If I ever get that agitated and restless, and dying, just cut to the chase, and give me Thorazine. Forget about the Lorazepam.’ :-)

One day...OK, so on several occasions when I went to see a patient in a nursing home who had pieces of food in his mouth. This patient was on a diet of soft food and had to be fed by someone. This patient had pieces of egg, and I don’t know what else in his cheeks and under his tongue, and decreased consciousness. This patient was on continuous (crisis) care for decreased level of consciousness, and pain. Anyhow, I used a spongy mouth swab moistened with water to do some extensive mouth cleaning.

That particular nursing home has a policy that the patients’ food had to be taken to the resident know matter what. Why!? That patient was never conscious enough to eat anything. This particular one was in the active phase of dying. These kinds should not be up in a geriatric chair either, unless that’s where s/he wants to spend the end of life. Come on now...she’s lying there lethargic, and her only reply if any at all is a weak, soft “uh,” and you’re going to feed her!? How would you like someone one sticking food in your mouth while you’re sleeping or in a sleep-like state? Possible outcomes: choking, suffocation, and/or aspiration.

For any medical advice or care plans please consult with your doctor or nurse, for each case is unique. My blog here is really about my and others’ experiences in hospice and palliative care. The highlighted words in my articles are links to hopefully helpful information.

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Healthcare Workers and Dignity

I work in the healthcare field, Palliative Hospice care,in particular. This message is really about all areas of healthcare. I believe if you're working in the healthcare field, whether in the office or direct patient care, you should be a loving & compassionate person. This includes those that are working in the administrative side of healthcare. If you're not loving, compassionate, and treat each other like a loving family, you are working in the wrong area; perhaps you should think about becoming a patient for therapeutic counseling. You certainly with a negative attitude should not be working in the healthcare field.

The people working in the field should not have to feel like they're walking on egg shells when they go into the office. Office staff should be willing to answer questions, and not say "It's not my area," without at least offering to find out who can help and refer you in that direction. Yes, I am an optimist. LOL.

My concern is that doctors, nurses, nurse aides, and administrative staff  be the leaders of love, compassion, and dignity in healthcare. Who's perfect? Well God is, but if we do the initiative to put out our best this would make for a better local community, then the world. Good news spreads, also spreads well and fast. If your company has a good reputation, it will have a long thriving life. 
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