Recently, this standing order set was suggested to my hospital’s ER (after some discussions with another ER’s director of nursing about ways to raise patient satisfaction scores):
“STANDING MEDICATION ORDERS
Emergency Department nurses may administer the following medications for pain or fever at
their discretion before an ED patient has been evaluated by a physician.
§ Acetaminophen 1000mg (or approx. 15mg/kg), or ibuprofen 600mg (or approx. 10mg/kg),
po x1 prn pain or fever.
§ Percocet-5, or Vicodin, 1 po prn moderate pain to a patient ≥ 40kg; may repeat once prn.
§ Fentanyl 50 mcg IV q 5 min. prn moderate to severe pain to a patient ≥ 40kg, to a
maximum of 250 mcg.
The nurse will consider such factors as the degree of pain, medications recently taken by the
patient, likelihood of the patient needing to go to the OR, and whether or not an IV may be
necessary for other reasons. Generic equivalents are acceptable.”
Excuse me. Did I just hear FENTANYL IV can be given to a patient in triage by a nurse with no provider evaluation?!?!?!?! To a maximum of 250 mcg?!?!?!And then they can just go back to the waiting room and sit there until they are called in?
This is the stupidest thing I have ever heard. Not only is it totally dangerous (people being given super high strength narcotics IV are then going to sit out in the waiting area with no monitoring at all – I can see having at least one to two respiratory arrests per month), but it creates a perfect situation for drug seekers. They can just come in, get their fix and elope from the waiting room! Probably with the IV still in place! Hell, even if they just get pain pills like Percocet, that is bad enough! I bet they’ll never even get registered! They’ll get their drugs and leave!
I don’t give a crap if my hospital started this policy, I would absoultely refuse to follow it and would document on every chart that the RN gave these drugs expressly without my knowledge or approval. Thankfully my director thinks the same way and there is no plan to go in this perverted direction.