Should you withhold Pain Meds if close to hospital?

[spenac]

So I used more pain meds on my patients last month than any of our other Paramedics. But as primary job is within 10 minutes to the hospital the director of nurses and me had a not so polite discussion about me interfering with doctors assessments of patients because I do pain management. The nurse said unless more than 15 minutes out I should not give pain meds. I told her my patients health and comfort come first not the doctors convenience and that any doctor that knows their job can still properly assess a patient that has been given pain meds. Plus if it seems to be hindering they can reverse the affects. So was I wrong? Would you withhold pain management?

Also I am fully in compliance with my medical directors pain management guidelines, so this is not me being a rogue medic.

Edited October 12, 2009 by spenac

[P_Instructor]

So I used more pain meds on my patients last month than any of our other Paramedics. But as primary job is within 10 minutes to the hospital the director of nurses and me had a not so polite discussion about me interfering with doctors assessments of patients because I do pain management. The nurse said unless more than 15 minutes out I should not give pain meds. I told her my patients health and comfort come first not the doctors convenience and that any doctor that knows their job can still properly assess a patient that has been given pain meds. Plus if it seems to be hindering they can reverse the affects. So was I wrong? Would you withhold pain management?

Also I am fully in compliance with my medical directors pain management guidelines, so this is not me being a rogue medic.

Bravo to you. I applaude your ideals in patient care and comfort. I however cannot vote on the second item, within 5 minutes. This is just me, as it will be dependant on patient pain tolerance and the conditions involved. Wrong....NO.

[itku2er]

Pain control is a major concern of both EMS and Hospital, or it should be anyway. People who legitmately need pain control should get it unless there is an underlying condition that prevents it like a suspected head injury or something. As a nurse I was drilled all through school patients comfort should be taken care of FIRST. You a rougue I will not comment on that one.

As long as you are following your protocols for pain control and the patient doesnt suffer then there shouldn't be a problem.

[akflightmedic]

You are doing the right thing and you already knew the answer before asking the question, however I like the topic creation.

I have given pain meds on the ER ramp, so I think you know where I stand. No doctor worth his weight in salt will ever say it interferes with his assessment. Plenty of docs medicate prior to seeing the patient when they do not have the time to get to them immediately.

I will never withhold pain meds based on distance to facility, meds are administered as the assessment reveals it necessary; everything else is irrelevant.

[flight-lp]

Ditto to the above responses.

I too have administered analgesics upon arriving at the ER and have also given them while waiting for a bed while extended at the ER. Most local facilities around here do not complain as they are aware their personal perceptual opinions are irrelevant to our treatment and that we will stand behind our argument that any competent physician can appropriately assess a patient with analgesia on board. Most of the decent agencies around Houston have very liberal (i.e. unlimited) pain protocols. My current guidelines allow for analgesia prn for as long as the patient can maintain consciousness and their own airway.

If your patient reports pain, it needs to be addressed in the appropriate fashion. Personally, I wouldn't concern myself with comparison statistics to other medics nor the impulsive concerns from a receiving RN.

Beneficence can and should go a long way!

[fireflymedic]

I am very proactive in controlling patients pain and I'm sorry if that ticks off the docs a bit, but I'm going to within my ability to do so and providing the patient is stable enough to allow it. Every patient is different so that would influence how far out I gave pain meds (within the 5 minute category). I think to withold pain medication is not only cruel but compromises patient care - pain increases heart rate, anxiety, among other things. If you can reduce that don't you see positive effects from it?

As to the being close to the ER, well, I'm going to go ahead and give meds if the patient warrants it because our ER's around here are almost always overcrowded and it takes the docs a bit to get around to see a patient sometimes. Sometimes it's even a bit before someone comes in to assess them (the nurses sign paperwork, ask for vitals, and leave). If they already have some pain control on board then it helps them wait out those long minutes.

From a patient perspective, I can say I've appreciated the few times I've received pain meds due to a few significant injuries I've had. It was one of the kindest things they could do. It at least took it from being almost unbearable to just discomfort which I could more than live with. Old people I've found are some of the most reluctant to take pain meds as most have been raised with the "suck it up" mentality, and younger people the most willing. That's solely an observation and much of it depends on the patient's prior experience with pain. If the worst thing they've had is a stubbed toe, then obviously a broken arm is going to be unbearable and if the opposite is true, then they will have a greater pain tolerance (which varies from person to person as well).

I hardly think you are overstepping appropriate patient care Spenac - you have put your patients care and comfort first, and I'm sure they thank you for it. You already knew your answer as others stated and I give you for your treatment of your patients. If a nurse fusses at you again, just calmly ask - if you were in this position wouldn't you want some analgesia? I'm pretty sure their answer would be yes. It's not cruel and it got alot of people in our area to change their mind set. Most don't want to give to due lack of convenience, it's one more thing they have to give, one more thing to chart. But when you flip the coin and get them to thinking about it being them, most will soften. Continue your compassionate care (wait did I just say that to spenac?) and always stay safe.

[tniuqs]

'akflightmedic'

You are doing the right thing and you already knew the answer before asking the question, however I like the topic creation.

Agreed.

I have given pain meds on the ER ramp, so I think you know where I stand. No doctor worth his weight in salt will ever say it interferes with his assessment. Plenty of docs medicate prior to seeing the patient when they do not have the time to get to them immediately.

I will never withhold pain meds based on distance to facility, meds are administered as the assessment reveals it necessary; everything else is irrelevant.

Yes again agreed, I have never been reprimanded by an MD although with RNs there can be a component of professional jealousy underlying and axes to grind very dependent on the RN, in vast majority of cases have to be approved by an MD first as we on occasions can be considered renegades thing is you just can't please everyone, so take care of the patient's needs first is my mantra.

Point in fact and a wee diversion,I had 2 patients both chewed on by a Grizzly Bear ... landed @ with helo and had to be grounded into a less than stellar rural ER and being well aware of the delays in assessment, quite typical for that less than stellar facility. I did not push that extra top up for break through pain (later became waste) this before a 12 minute ground transport ... well yeah know I will always regret that as once through the hospital door I was not "allowed" to use my own meds ... The MD kinda pissed me off too and the patient and because despite my suggestion of top up with my own meds and soaking off with N/S the now clotted and dried dressing (a major avulsion) and against the patients request too, he ripped it off causing more pain in his haste to "assess" ... live and learn I guess.

spenac: On another note, I would be cautious as one operation I worked for did evaluate the high narcotic usage of one fellow Medic ...to find that he was having some personal issues with controlled substances and got caught red handed umm how can I put this .... pocketing the waste so watch your back and document very well with a independent and trusted co signer.

ps Billy Smack is no longer on the streets, thank you very much.

cheers

[fireflymedic]

Something to ponder within this topic - it's a good read and really breaks down the pain med options and their durations, actions, etc (thanks Dr. Bledsoe)

http://www.bryanbledsoe.com/data/pdf/mags/Analgesia.pdf

[Dustdevil]

Unfortunately, anyone who's been in the field awhile knows the ugly truth; you don't have to do anything wrong to get shafted. And if nurses, doctors, or other medics start talking shyte about you, you're likely to be labelled unfairly, potentially resulting in problems. It is extremely important to keep your documentation ducks in a row, as well as communicating concerns with your medical director. If someone complains to you, relay that to your MD for his input. Anytime a concern about you gets to him, it should come from you first, not through the rumour mill. He who gets his story in first wins.

Just assure that you are indeed fully within your protocols, communicate effectively with your MD, and put your patient's first. That's the best way to hedge your bets and stay out of controversy.

[tniuqs]

He who gets his story in first wins.

Yes again a very down to earth advice ... its sad really but it is now the way of the PC world.

cheers