Re: ACOG Antepartum Record - Pain Scale?
From: R. Daniel Braun (rd.braun@gmail.com)
Sat Nov 24 18:26:58 2007
I relly love the patient who is sitting there talking to me and smiling
while asking for codeine T-3's don't work. The nurse has recorded a pain
scale of "10" and it also says pt. states pain continuously present.
Obviously the patient doesn't understand the pain scale or is seeking drugs
and what is worse: neither does the nurse or else the nurse really just
doesn't care because he/she has done what they are supposed to do. i.e. ask
and then write down the answer. In the Hospital run clinic where I used to
work, the pain scale had to be recorded at at every visit. This started
about 4 or 5 years ago as mandated by JCAHO.
Dan
On Nov 24, 2007 4:28 PM, Joanne Bulley, MD <islesannie@gmail.com> wrote:
> About 6 months ago our hospital clinical monitoring committee reviewed
> the information about some people being "rapid metabolizers" of codeine
> (into morphine) and thus able to get much higher levels of morphine in
> the blood stream with the complications of excess narcotics and all that
> entails.
>
> So we reminded all docs about this and Anna's recommendations fit right
> into that issue.
>
> Joanne
>
> At Fri, 23 Nov 2007, Meenan, Anna wrote:
> >
> >A small percentage of moms (it varies by ethnicity) rapidly
> >metabolize codeine to morphine. I wouldn't say codeine is
> >contraindicated in breastfeeding moms, but needs to be given for only
> >a few days, and if pain continues, the situation needs to be
> >re-evaluated, which is why I have to keep reminding my residents not
> >to send more than 2 or 3 days worth of T3 home with breastfeeding
> >moms and to tell them to call if still having pain requiring
> >narcotics when that runs out.
> >
> >Anna Meenan, MD
> >
> >>In the UK a post Caesarean breast feeding patient kept complaining
> >>of pain (no apparant cause) and was given repeated doses of
> >>codeine.There was a neonatal death on day 15 suspected to be due to
> >>resp.depression.Therefore now is strictly contraindicated in breast
> >>feeding women
> >>Aditi
> >>
>> >>>----- Original Message ----
> >>From: "art fougner, md" <evsono@pipeline.com>
> >>To: Multiple recipients of list OB-GYN-L <ob-gyn-l@dns.obgyn.net>
> >>Sent: Wednesday, 21 November, 2007 5:47:57 PM
> >>Subject: Re: ACOG Antepartum Record - Pain Scale?
> >>
> >>She's Dead, Joe.
> >>
> >>Art
> >>
> >>At Wed, 21 Nov 2007, <mailto:DoctorJoe@aol.com>DoctorJoe@aol.com wrote:
> >>
> >>>You know, (1) you can't trust the patient not to be faking, and (2) you
> >>>don't want to be embarrassed by a lawyer ("Didn't you see, Nurse
> >>>Jones, that when
> >>>you recorded 'asleep' the patient wasn't breathing and his tongue was
> >>>lolling out to the side? The patient was DEAD, Nurse Jones, he was
> DEAD!!")
> >>>
> >>>Joe P.
> >>
> >>--
> >>art fougner, md
> >>"May The Wings of Liberty Never Lose a Feather." - Jack Burton
> >>
> >>For ideas on reducing your carbon footprint visit
> >><http://uk.promotions.yahoo.com/forgood/environment.html>Yahoo! For
> >>Good this month.
>
> --
> Joanne Bulley, MD, FACOG
> Solo gyn
> Keene, NH USA
>
--
R. Daniel Braun, MD FACOG(L) CMT
Professor Emeritus
Dept. of Obstetrics and Gynecology
Indiana U. School of Medicine
R. Daniel Braun
"Science without Religion is LAME; Religion without Science is BLIND"
Einstein 1941
