AIBU or was midwife stealing my morphine?

[Morphinemidwife]

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?

Thats appalling, contact PALS and put in a serious complaint. I've known many nurses over the years who have falsified drug records either because they were too lazy to give the drugs or addicts themselves. This MUST be investigated so it doesn't happen to anyone else. And don't let anyone convince you you are the one going mad here.

20mls of oramorph would be a massive dose regardless of concentration, even 20 mg of oramorph is huge. It generally is prescribed 4-6 hourly.

I take a lot of oramorph, have done for 8 years or more after an accident. Obviously some days are worse than others. But I can honestly say that although I’m so used to taking it, when the pain is really bad and I take my max doses I do have to write it down, because if I didn’t I can easily forget if I’ve taken it- and that’s not the oramorph causing it, it’s the level of pain causing it.
I’m not saying this is what happened to you by the way, just giving my experience, answers how pain can affect your judgement.
Whatever has happened, contact PALS, as others have said, if it was being taken by another person, this could be another piece of the puzzle. Hope you are recovering well and enjoying your little bundle.

The dosage you’ve quoted is incorrect - the recommended dose is 10-20 mg (5-10 ml) every 4 hours.
Maximum daily dose: 120 mg per day

www.medicines.org.uk/emc/product/902/smpc

When I had my c section, I was given a little cap of morphine, I think 5ml? Every 3 hours. I was still in some discomfort with that dose after the first few but able to cope. The midwife asked if I needed to change to 10ml and she would go and get a doctor to sign off a prescription for 10ml instead but I said I was ok on the 5ml as I felt a little spaced on 5ml and thought 10ml would be overkill and I would be off my face. She said she could arrange to change it to 5ml every 2 hours if that would help and I said yes. So the first 3 doses were every 3 hours and 5ml then the next 3 doses were every 2 hours and 5ml. I think it was the spinal wearing off that urged her to reconsider my dose and offer options

prescribed me 10-20ml of oramorph every 2-3 hours.

Highly unlikely. I don’t think you understand the dosage. As others have said, Oramorph is 10mg per 5mls so you wouldn’t have been prescribed 20mls equating to 40mg every 2-3 hours.

What I find more alarming is that in your apparent misunderstanding you have immediately jumped to the conclusion that a hcp is a drug abuser and a thief and others on this thread are encouraging you to report her.

Why anyone wants to be a hcp these days taking this shit is beyond me.

Isn't the amount quoted rather high

Oh come on op how could you notice pin point pupils if you were in so much pain you could hardly speak?

Sorry OP but I think you may be confused about the events, understandably, as you were in a lot of pain.

I have never seen a prescription chart stating something to be administered every 2 to 3 hours, they just aren't written that way. And the nurse wouldn't have been able to even get to the oramorph without another HCP, due to the way drugs are stored, a colleague would have had the controlled drug key - it's effectively a locked box within a locked box.

For your own peace do ask for a meeting with the supervisor of midwives who will have your prescription charts etc and can go through all of this with you.

Contact PALS and ask to see you medical notes, someone will sit with you and read through them and you can ask for an independent person not involed in your care to also review. It is possible after your spinal and morphine pump your concept of time and how much you had was a bit muddled, especially with mgs and mls.

I am a nurse and on a few occasions nurses I worked with were suspended for suspicion of stealing temazapam or oromorph and all became controlled drugs, needing to be signed by 2 nurses. But denying a patient in pain and stealing their drugs, never to my knowledge but it could happen of course. I am sorry you had this experience after birth, I hope everything is ok now.

She gave you the correct doses. Yoive consider ml for mg. Maybe by telling yourself all night long that you hadn't had the pain relief, you made your own pain worse. A lot of it is psychological. It doesn't mean the pain wasn't real, but if they'd given you more then you'd have overdosed.

As an ex nurse, oramorph is always checked and administered by two nurses. 10mg oramorph equals 5 mils. There's no way your midwife was self administering your pain relief. No way.

This doesn’t quite add up. If you were there for five days then different nurses/midwives would have been caring for you day and night so even if one was stealing your morphine I highly doubt they would all be in on it.

I’m not saying it doesn’t happen but this is a very serious accusation and if you aren’t 100% sure of the dose you received (as many have pointed out there is a difference between mg and mls) then you need to tread carefully.

Nope. You've got it wrong. Shame on those who don't understand the dosage or how it is administered trying to get the op to "report her".

It’s possible she was moving oddly because she was fucking shattered on a night shift.

Morphine can have some unpleasant side effects, hallucinations, sickness, make you sleepy, itchy, any of these plus your general recovery and looking after a new baby, could affect how you viewed things.

I’m not saying this drug stealing doesn’t happen, mind.

I think they are checked by 2 members but not administered. That's why it takes some time to get someone else to check it and then come back and give it sometimes.

Phoebesgift Oramorph does not have to be double checked.

So not only was the midwife stealing your morphine she was supposedly taking it herself whilst dealing with her patients

I've had two CS under GA and I never had anything like the amounts of oramorph you think you should have had, nor for that length of time. (Never had a morphine pump either!).

Op I am prescribed oramorph as others have said you have the doses confused.

20 mls of oramorph is a huge dose, so very unlikely this was prescribed for you. It is also usually a medication dispensed as required and not regularly. That’s 40mg of morphine in two hours which is a massive amount.

Morphine can have some unpleasant side effects, hallucinations, sickness, make you sleepy, itchy, any of these

I had oramorph during labour and I was off my tits, apparently I was chatting away 10 to the dozen about all kinds of random stuff, but I dont remember any of it 😬

Plus if you are addicted to opiates it’s not worth the effort or risk to steal 5mls/10mls of oramorph from a patient. You’d take larger amounts from ward stock instead.

Was definitely given 5ml. It was in a measuring cup that I saw and drank out of.

I may have misread the ml/mg, but even if this were the case, she was still giving me the minimum prescribed dose of 10mg and refusing to give me the higher dose of 20mg even as I reported a constant increase in pain. It was also most certainly written 20 every 2 hours on the chart.
I never saw her remove it from the trolley or pout it out, it was always on top of th drugs trolley when she came in. The timings were most definitely correct, I was having it half as often as I should. So possibly 30mgs rather than 120mgs over the night if I misread mg/ml, still a huge discrepency. I said I was given 5ml and indicated on the cup, they said that wasn't true.
The dose the initial Dr gave me was the whole little plastic cup, the subsequent doses were certainly 5ml.

I assumed she was starting me off on a smaller dose.

@AlexaAmbidextra I didn't jump to her being a drug addict. I spent 6 weeks thinking she made an admin error until it occurred to me recently that she was clearly off her face, DH remembered her pupils too, and he fully believed they were telling the truth at first.

The dose of Oramorph is often very confusing as it is 10mg/5ml solution.

So 10mls = 20mg, 5mls = 10mg.

It is very unlikely someone who has never had any morphine before would be prescribed 20mg Oramorph 2-3 hourly but much more likely they would be prescribed 10mg (5mls) 4-6 hourly as required, or just ringing the times on the drug chart which are usually 8am, 12, 17, 22 or near enough.

Depending on the workplace, Oramorph isn't a controlled drug so doesn't need to be checked by 2 nurses. Some places will treat it as one, but many won't.

Probably just looking at your drug chart would clarify what has happened as I would guess there is a mismatch between what you think the anaesthetist told you would happen (which honestly sounds dangerous) and what actually got prescribed.