Giving narcotics at triage

[gharley]

Does anyone dispense oral narcotics for pain at triage before a patient is seen by a doctor? My hospital will have protocols on what to give. I am interested in what my liablity is if the patient leaves without seeing a doctor..

[maggie9307]

NO!! We as nurses do not order meds. most hospitals have standing triage orders for tylenol and motrin. narcotics never!! very dangerous practice. you will have regulars just coming for the narcs. and narcs may scew the dr's assessment.

[jaxmomg]

I would never dispense narc's in triage. It becomes a huge liability to you if the patient leaves prior to being seen by the physician, drives and is in an accident under the influence. Also - the physician may not cover you and write for it if something happens to the patient in the waiting room off the monitor. For example, if I have a patient which I medicate with Dilaudid I put that person on the monitor for about 30 minutes or so.

[peady2]

If the hospital has written protocols about giving narcs at triage, then they should include what is expected of the triage nurse if the patient decides to leave w/o being seen. As long as you strictly follow a written protocol (keep a copy for yourself) that has been approved and signed off on by both nursing admin and the medical exec committee, and document accordingly, I don't think you should have any liability.

That said, I personally would prefer not to do it, and I would ask to be on the committee developing the protocol so that I could offer input that makes me comfortable with the task. If you remain uncomfortable after all the above has been done, and they decide to implement this protocol, you will have to decide whether or not you can continue to work there.

BTW, if you are unionized, make sure you bring it to the union's attention, who will have only your best interests and potential for liability at heart. If they are OK with it, you should feel comfortable doing it.

[Edson!]

I don't understand why there is treatment without eval by physician, NP, or PA. I mean I'd have to know the exact parameters of the written protocol. Hmmm.

[hoochy]

As a triage nurse you would be expected to perform good assessment of the client needing narcotics, the extent of their pain and if they are a risk of self discharge. Our hospital does have a clearly written protocol of nurse initiated analgesia and we are able to give IM or oral analgesia, including narcotics, but not IV. The client needs to be advised against leaving the department with reasons why, have a responsible adult with them at all times and be clearly on view of nursing staff. Unfortunately there are instances, though rare, when the client leaves prior to being seen by the doctor, clear documentation by nursing staff and clearly defined written hospital policies will save you from any legal embarrassment if/when this does occur. Do not stress! Just ensure that any new procedures/policies implemented by your hospital/institution are clearly defined, in easily accessible written form, and covered by yor state/province nursing laws/guidelines.

[reesern1963]

When I worked in triage we had all sorts of standing orders for things, but not narcs. The frequent flyers would have made life a misery.

About the only people who got narcs right off the bat were people who we thought were MIs; they got morphine. Other than that, I can't think of anybody who got narcs without a once-over from the ED doc.

I sure wouldn't want the liability involved in this.

[nuangel2]

no absolutely not .pt needs to be seen by np or pa or md.

[nursingreview]

no absolutely not .pt needs to be seen by np or pa or md.

i think it is true

[watersleepexercise]

So is it ever the case that nurses give narcs at triage? I mean, is it a pretty universal rule that they don't, or can it vary from hospital to hospital?

[MarieAnderson]

All medications should be advised by the physician first before giving it to the patient.

[wanderER]

Yup, patient must be seen by a licensed provider (nurse practitioner, pa, or physician) prior to receiving narcotic medications. Every ED I've ever worked in has standing protocols for tylenol/motrin administration @ triage for pedi fevers with a temp recheck in 30 minutes if they haven't been roomed yet. I also tell patients not to take their own meds before they're seen by a provider either, but they don't always listen...sigh. Could you imagine the liability if you gave a narcotic at triage & a patient left before being seen, was in an MVC and killed someone?

[cassondrarn]

Hi,
We have "nurse initiated orders" that allow PO lortab for migraine within certain criteria. The issue that was just presented to me yesterday, is that we have an NP at triage doing "rapid medical eval" and in that process ordered hydromorphone IV on a couple patients. In my own practice, I put a patient on SAO2 monitoring when I administer narcs and of course the ability is not there when they are sitting in the waiting room. When I asked the question of management I was asked, "where is the science behind that?" Does anyone have "science"?
Thanks

[NURSEDETROIT]

Even the thought of providing "Narc's" of any type in Triage is ABSOLUTELY ABSURD! As indicated in prior posts, there are too many problems with this that could result from this practice. As "cassondrarn" noted; for management to even have questioned this is absolutely absurd, "Where's the science?" PLEASE> Do not insult our expertise/experience . . .I would have replied, "The science against this practice lies in it's very nature." That type of response from management typifies the disrespect and outright contempt for our collective educated/informed opinions. It reinforces the unrealistic expectations management holds. Mgmt., Nursing and Non, are all so far removed from any actual situation; further, they are insulated from all the liability thereof. It's outright abuse.

[ciprian21]

Right on This!