Why does it feel like it takes forever and a day to acquire pain relief while in the hospital?

I have knowledge of bedside nursing in the ICU and the ER. Patients suffer from aches in each specialty area. The period between asking for alleviation and receiving oral or intravenous prescriptions varies depending on protocols, staffing, method of dispensation, and charting systems. The nurse is not withholding pills, being lazy, or ignoring calls.

Protocols and Procedures

Protocols and procedures exist to protect the healthcare facility, staff, and those seeking care. It prevents pharmaceutical errors and ensures the correct patients receive the correct therapy. When a patient expresses discomfort, they ask the nurse for a remedy. The nurse needs to call the provider. The provider inputs this order into the electronic charting system or transcribes it down on a prescription paper.

This written instruction proceeds to a pharmacist, whose job is to verify if this analgesic is safe for the patient. They examine interactions between all the treatments on the chart. Some remedies cannot be taken together because they can increase or decrease their effectiveness. Pharmacists watch lab results to determine liver and kidney function because these organs excrete pharmaceuticals. The pharmacist must verify and approve the requisition on the electronic medication administration record (EMAR) before the nurse can give anything.

After verification, the EMAR updates and connects to the distribution system. There is either a physical dispenser that holds the most common elixirs, or the pharm tech sends the pills directly to the nurse via a tube system or a runner. In the pediatric world, drugs are weight-based; therefore, a majority of treatments are drawn up for each individual child and sent to the room one by one.

The charting system of the healthcare system determines how all these processes talk to each other. The physician request, the pharmacist verification, the pharm tech slip, and the dispensing system all need approval before allowing the nurse to remove the tablets and administer them to the patient.

Staffing

Staffing affects this process because each step requires a human touch to continue the progression of the protocol. The physician is accountable for 5 to 25 patients at once. At night, the total number can be up to 35. This makes getting hold of the doctor difficult. It takes a spell for the provider to sign the directions. They must prioritize care depending on their load. If a patient is crashing in one room and they are the only provider at night, then they cannot stop coding the patient to write noncritical orders.

The pharmacist is responsible for everyone remaining at the center. Checking laboratory values and interactions takes time, and this safety feature is important. Shortcuts and overriding this investigation put populations at risk for overdoses and adverse reactions.

Runners are employees who transport supplies, capsules, labs, and equipment around the building. They get their minimum step count each day they work. Without them, the nurses have to leave the bedside. When there are not enough runners to manage the demands of every unit, deliveries take longer.

All this needs to happen before the nurse can administer the medication. Once the order and the drugs are at hand, the nurse will double-check, scan, and give the dose. At this phase, 30 minutes or three hours can pass.

Plan

Obtaining medicine in the hospital is far more complex than at home. As a nurse, I anticipate the needs of the patient. I look at my EMAR at the beginning of the shift for therapies for discomfort. At a minimum, I like to have Tylenol, Motrin, or an IV adjunct if the patient cannot swallow. As a patient or family member, ask for relief before the unease is unbearable. Do not wait to call the nurse until the discomfort is 10 out of 10.

Nonpharmacological methods are useful adjuncts to ease the body. Dimming lights, closing curtains, playing music, and distraction can assist with pain management. 

Healthcare systems have protocols to keep people safe. It creates processes that take time to complete. It is not malicious. It is important. The goal is pain management, improving patient outcomes, and patient safety.

Editor: Claudia Cramer