to Expect rules to be followed by nurses while my daughter is in hospital?

[Skmo1]

My 16yr old daughter got taken into hospital by ambulance this morning with severe stomach/abdominal pains. A&E, cannula in hand, pain relief (morphine through the cannula, then admission to ward and all very quickly! fantastic. As she is 16, shes in adult wards rather than children’s. She was very apprehensive about me not being able to stay over night with her plus she has anxiety, which brings on panic attacks about things like that! She phoned me at 8.30pm & told me she’d started feeling sore again & asked the nurse for a morphine top-up, (on docs request) nurse told her 5mins it would b with her. Nurse came back, alone & handed her a syringe filled with clear liquid & walked away! My daughter didn’t know what to do. It’s her first ever stay in hospital and also her first ever time having morphine. First time she has saw morphine was when she was down in A&E and the doctor put it straight into her cannula! She was a bit puzzled as to why SHE was GIVEN a syringe full of morphine, then left to her own devices. It’s very lucky she’s a bright girl & thought to ask before She whacked it through the cannula & it’s very very lucky she did ask as it was actually ORAL morphine, she was supposed to swallow it! So, shes got talking to a couple of women on the ward....as u do! One woman had blood and other bodily fluids all over her bed sheets from her admission on Fri. They havent been changed, at all. The same woman & another had violently vomited on Fri night and both their sick bowls are STILL sitting on their tables that go over the bed.....tonight (Sun).

So much for the hospital being vigilant in staying clean to Reduce the risk of patients catching superbugs like MRSA etc!! And also breaking controlled drug procedures completely to the point of negligence!

Am I being over the top???

Yes, lots of us would have no idea. I take about one head ache pill every 10 years. I have never had an injected pain killer. I have had one night in hospital in my entire life after a normal birth (with gas and air as pain relief). I would be really puzzled if I were given a syringe with anything in.

I sometimes think if I ever needed to go into hospital I would want to pay someone to pretend to be a relative to be tehre as much as possible to bring in decent food and look after me. I will instead try to avoid hospitals entirely if I can.

Might be worth noting that purple syringes are not rolled out nation wide. I work in a Scottish trust and we don't have that policy.

Im in the West of Scotland and Oromorph is not a controlled drug. I was on it for 6 months at the start of the year after a 2 month hospital stay.

skimo1 2 hrs does seem like a long time but as you say they have to do lots of other patients and cant just drop everything the minute someone asks. I guess if its at a time when they are going round giving out scheduled medication then she might have to wait

No, this is not correct. If a patient says they’re in pain, they should be prioritised.

Yes, they should be prioritised, but I've had to wait hours during the night for IV pain relief.

And 7-7.30am is when the shift changes from night to day, and they have to discuss everything from the night, when handing over to the day staff. Doctors do their rounds later in the morning, and at my hospital, they took bloods at about 9.30.

unfair but the timing maybe the clue - between 7 to 9 ish is changeover time from night to day staff at this time day staff will be having " staff meeting" to update on patients & wards

At 16 patients can be on adult wards. Some go through adult ED, some get the choice and it depends if they’re in full time education. Sometimes it depends on how much space we have.

Wherever I’ve worked on children’s ward oromorph is a controlled drug and requires two nurses to check and administer.

No, this is not correct. If a patient says they’re in pain, they should be prioritised

Even if someone is bleeding out, got sepsis, having problems breathing or has a heart attack? Please be realistic!

FruitCider Ok, but the post I was quoting mentioned (from memory do I might not have this exactly right) the morning medication round causing delays in pain relief, not any kind of life-threatening/emergency situation

As above by fruit and what if everyone is saying they need pain relief at the same time?? (Am clearly being pedantic !)

Yy I’m sure there’s probably a good reason. Just from personal experience I’ve worked with some nurses who think it’s ok to leave CDs until the end of the med round, even if the patient is in pain. I personally think this is not very good nursing, but 🤷‍♀️

I’ve worked with some nurses who think it’s ok to leave CDs until the end of the med round, even if the patient is in pain. I personally think this is not very good nursing

I can be difficult sometimes though as there’s not always a second checker available straight away for controlled drugs. This often caused delays in administering anagelsia on the ward I used to work on.

Where I have worked oramorph is kept in the drug trolley so doesn't need to be got from the CD cupboard or double signed. 7.30 is may be the time that nurse was going off duty, or just come on duty. I've seen the nurses asking patients if they have any pain when they do morning obs which are often around 6.30 but we weren't there so don't know what happened. Best thing is to speak to the nurse in charge or ward manager. If you forget the reassurances you need ask to speak to the on site manager, they are senior nurses.

Just to say, oral syringes won't connect to iv cannulae these days, so hopefully she wouldn't have been able to inject it if she tried. That does all seem a bit rubbish though, not nice to be unsure what to do when you feel unwell anyway.

Depends on what syringe is used for oral. We use purple ones for any sort of oral feed/ng tube. But the syringes which oramorph are given out in are ordinary white iv ones.

I am a nurse and qualified to prescribe.
Regardless of the medication if I had a distressed 16 year old in my care I would check for allergies, last time meds were taken (to avoid accidental overdose), check ID, ensure the medication was taken correctly and by the correct route(eg oral, iv, topical etc). It would take less than 30 seconds so there is no excuse for walking off and leaving your daughter alone.
I’d also check if it was the same pain or something new, are whether the previous analgesia helped. It would be necessary to check back periodically to see if it was effective, and especially with an undiagnosed condition which might deteriorate or change.
There is absolutely no excuse for dirty sheets/ body fluids left around the ward, I am appalled.
I think you are quite right to be concerned and I would discuss as objectively as you can with the ward manager. Keep notes of these incidents and people’s names n case you wish to make a formal complaint.
I hope your daughter makes a complete recovery.

How's she doing OP?

As above by fruit and what if everyone is saying they need pain relief at the same time

You have to just prioritise and work your way through who needs what. Or you just do what we do in paeds, no drugs rounds.

It goes in your gob. Not in the canula.They should have explained that and stayed with her for the first dose.

My Oramorph was given in a clear syringe. It looked exactly like the ones that connect to canulas. The nurse should have supervised.

There is very, very little anybody can add to MrsDrudge’s post. Spot on.

The situation your daughter describes is unacceptable. End of story. No amount of 'she should have known a purple syringe means oral administration' quite cuts it. If the service is too stretched to get this right then they need to stop paying for paracetamol, hay-fever tablets, aspirin etc. Ffs

And yes, oramorph is CD schedule 5 so controlled, but very low down on the list and requires no extra paperwork. But even paracetamol should be administered with care, so I have no idea why so many people are chiming in talking about the registration status of oramorph. Any meds administered should be administered with care.

Sounds like a horrible experience for you both.

Just to reassure, oral meds are given in oral / enteral syringes which aren't compatible with IV cannulas, so even if your daughter had tried to administer meds intravenously, she wouldn't have been able to.

Not ideal though!

Sorry OP I can only access the first page of comments so appogies if I'm repeating things. I've worked in hospitals for 20 years and am a nurse consultant so thought I'd give my pennies worth!

As others have said, oral morphine is not a controlled drug. Unfortunately ward areas (ie not ED, ITU recovery etc) rarely give iv morphine as in theory the patient needs close monitoring. I have had a groan from nurses more than once when I've prescribed it!! However the nurse concerned omited basic bedside checks done before meds are give. Had this been done your daughter would Have been told the route, orally. This is unacceptable, her being so young makes this -in my mind- worse.

The infection control and basic lack of hygeine is another , unacceptable issue.

I would strongly advise you ask to talk to the ward manager in the first instance to attempt improvement whilst your daughter is there. Secondly please follow this up in writing with Pals. 16 yr old are a contentious issue , my trust has the same policy. Unfortunately most of the adult wards are not appropriate for a 16 year old. Occasionally rules are bended but it is rare.

I hope the rest of your daughter's admission was improved!

It is a bit dangerous that everybody is going on about Oramorph not being a controlled drug. There is Oramorph Concentrated, which is actually higher in the controlled drug register and as humans love to abbreviate things somebody might have this prescribed and from this thread think that it is the same thing. In my mind it makes no difference if it is a controlled drug or not. Any prescription-only medication left in an unlabelled syringe with no instructions is a serious incident which needs to be reviewed.