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AIBU?

Share your dilemmas and get honest opinions from other Mumsnetters.

AIBU or was midwife stealing my morphine?

340 replies

Morphinemidwife · 02/11/2019 12:05

Slightly longwinded background for context:
I gave birth to my DC around 6 weeks ago, ended up having a caesarian under GE so no spinal block, and a lot of complications that meant over 6 hours in surgery.
Came around in agony (spinal block apparently offers longer term pain relief), so put on a morphine pump at the request of the anesthetist from surgery and a registrar. All fine, lovely night changing and cuddling baby, some pain obviously but totally manageable and under control.

The same registrar and another Dr came later to remove the pump before ending their shift, and prescribed me 10-20ml of oramorph every 2-3 hours. Said to keep on top of the pain, as it was hard to get it gone but that it should be trivial to stop it coming back. Had first dose, few hours pass, all good still.

One midwife was responsible for me overnight, her shift starting soon after i came off the pump, she was administering my medication. She gave me 5ml of oramorph very infrequently - every 4-6 hours over the night, despite my frequent buzzing in absolute agony. By the morning I was in tears, groaning, high temperature and completely unable to move. She kept saying I should be mobile, when I couldn't move for pain. When my pain was being managed I was able to pick up my DC to change and feed etc, by this point I couldn't move to sip a drink despite being very thirsty. The midwife wrote in my notes saying I was failing to cope and look after my baby and my husband was having to take over instead. I just needed pain relief.

When the morning shift came, I asked whether I could have the full dose of oramorph as frequently as prescribed as my pain was completely unmanageable. I'd realised it had been a lost cause trying to get the correct dose overnight.
They said I couldn't, as my chart showed I'd had the maximum possible dose - 20ml every 2 hours. All signed off.

I insisted I'd had 5ml every 4-6 hours, nobody would believe me. I wasn't allowed any morphine, just paracetamol. I was in an astronomical amount of pain. This prompted a mental health referral. Overnight I had been given 15ml of oramorph, my chart said I'd had 120ml.

I had a mental health Dr come to pointedly ask me whether I had any drug problems as there was no way that dose would leave me in agony, I accused of having a mental breakdown and being "unable to cope" all day. I was accused of wanting extra morphine because I needed "an escape". I was fine, overjoyed other than the pain, just lacking any sleep and in need of pain relief. I didnt feel able to repeat my assertions that my chart was wrong to the mental health Dr, as it had prompted the referral and mutterings of SS involvement.

I ended up having to stay in hospital for 5 days, having been desperate to go home as they were concerned for my mental health because I was crying all day due to being in total pain. Being on the ward robbed me of any chance of sleep, my paracetamol wasn't even administered regularly so I only made it home when on day 5, the pain had naturally eased off a bit so I stopped crying and groaning.

Went home, giddy and happy with a new baby so thought no more of it and didn't want to focus on the negatives of the first few days.

But its just occurred to me, weeks later, how the midwife looked and was moving, her pinpoint pupils. She was taking my morphine and forging the chart wasn't she? It's bloody obvious to me looking back that it wasn't just an error like I'd initially thought.
WWYD? I could never prove it, could I?

OP posts:
EvenMoreFuriousVexation · 03/11/2019 12:32

Just wanted to chime in with Moondust001 that morphine sometimes just doesn't work on people. I've only had it once, following surgery a few years ago, and it did nothing for my pain levels and simply spiked my blood pressure, meaning I was on 15 minute obs all fucking night - imagine trying to sleep on a ward with several other people, unfamiliar bed, and then a cuff on your arm keeps inflating 4 times an hour?!

They ended up giving me Fentanyl as a one-time dose immediately following surgery and fuck me, I was smashed off my face. No wonder it's got huge street value. I used to work in care - we had constant issues with patients' fentanyl mysteriously going missing shortly following a visit from a ne're do well relative or neighbour.

Anyway - the rest of the day after surgery (I was first on "the list" so I think I was back on the ward by 1pm) and the night is a complete blur. Pretty sure I listened to the entire radio adaptation of "Good Omens". Can't remember a bloody word of it!

HappyHammy · 03/11/2019 13:35

A lot here doesn't make sense, surely the day shift would have spoken to someone about the alledged discrepancy, if a patient states they only had 3 small doses and the drug chart stated something massively different wouldn't they have asked the midwife at the time what was actually given and if they felt suspicious then investigated this at the time? Also wouldn't a doctor have reviewed pain and analgesia the day after especially with a patient who had been so poorly. Do the mental health team take referrals from midwives or would that have been doctor to doctor.

Greywalls12 · 03/11/2019 15:27

@HicDraconis it's against our trust guidelines to administer anything through a line running blood or blood products.
Although possible to give morphine (dilated and only through red cells) through the same line, our trust advise no medication through the same line in case of mistakes.
There are very very few medications you can run through the same line as blood/blood products.

Greywalls12 · 03/11/2019 15:30

@HicDraconis actually surprised you don't know this if your an anaesthetist. Do you not do blood transfusion training?

FormerlyFrikadela01 · 03/11/2019 15:42

it's against our trust guidelines to administer anything through a line running blood or blood products.

It's not just your trust guidelines. It's best practice because a lot of drugs are incompatible to run with a blood product and if you administer after the blood has gone through without changing the giving set it can block it (at least that's as much as I remember from training, I having touched an IV since I was a student).

Greybeardy · 03/11/2019 16:10

To the people stating your ‘can’t give drugs with blood’...what do you think happens when you give drugs into a vein?! It mixes with blood and it’s no different to giving it into a line with a transfusion running! In an ideal world it’d be nice to have separate lines for everything but in the real world of emergency surgery that is not how things always work out. If there was a problem with giving analgesia and blood in the same line believe me we’d know about it by now. (DOI: also an anaesthetist).

Hearhoovesthinkzebras · 03/11/2019 16:54

We were never allowed to administer drugs at the same time as blood either. We had to flush the cannula first, administer the drug, then flush again before re starting the transfusion.

Greywalls12 · 03/11/2019 19:04

@Greybeardy i absolutely understand the need to give medication in an emergency and if the only line the patient has is infusing blood, then by all means I would use it, in an EMERGENCY SITUATION.
However, @HicDraconis said they didn't understand why nurses do not use the same line when patient is in recovery, NOT an emergency situation, hence me mentioning the guidelines.
There is limited evidence of the physical and chemical compatibility of thedrug and it interactingwith the bloodand any preservatives or additives in theblood product, which is i believe, why it's against transfusion guidelines.

Greywalls12 · 03/11/2019 19:06

It mixes with blood and it’s no different to giving it into a line with a transfusion running!
The blood in your veins do not have preservatives/additives in it, thus making it different.

HappyHammy · 03/11/2019 19:18

In an emergency or for a blood transfusion youd probably have a large cannula and fit a triple lumen extension. Guidelines do not recommend giving blood through the same lumen do they? Surely youd just pause the transfusion and give the drugs, there are guidelines on this on the blood transfusion site.

Mushypeasandchipstogo · 03/11/2019 19:34

Just to echo what others have said. Morphine had very little affect on me after my CS. I was screamed at by the nurse after I walked up to her office after about half an hour to ask for something else as it definitely wasn’t working.

HicDraconis · 03/11/2019 20:33

@Greywalls12 There is no reason why you can't inject an opioid into a line which is also running packed red cells or plasma. All IV guidelines prohibit all drugs into a line running blood though, which is daft as it's essentially no different to putting it into a vein. Hence I have never understood why nursing and IV guidelines don't credit nurses with common sense and pharmacological understanding in terms of what is and is not compatible with blood.

The only fluid you have to be cautious of putting up immediately after blood is hartmann's / ringer's lactate (because of the calcium content) and all the nursing staff I have worked with know that.

Can tell that @Greybeardy is also an anaesthetist ;-)

HappyHammy · 03/11/2019 21:02

Hic. If you inject something into a vein then isn't it usually flushed beforehand and after plus you've got constant blood.flow.moving it all.along. is there a risk of the blood sticking or incompatability if you use the same line.

HesterLee · 03/11/2019 22:47

Isn't part of the reason for not infusing anything else with blood (except in an emergency) that if the pt had a reaction, you wouldn't know if it was to the blood or the drug.

NewYoiker · 04/11/2019 00:37

@HesterLee yes. So very rarely a patient will react to blood products and will need immediate treatment for that reaction. But if you infuse Drugs at the same time you wouldn't know which product the patient is reacting to so you can't take steps to prevent the reaction in future

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