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?

@MaybeitsMaybelline it wouldnt have been a similar dose.
She would have had 3x what I'd had, according to the chart discrepancy.

@Passthecherrycoke

A debrief or at least, seeing her notes, would confirm to the OP that the dose she thinks she should have been given was incorrect as it’s an overdose.
I’m not doubting you @Morphinemidwife that you were given 5ml every 4 hours, I’m saying it’s a standard low dose. Also, your pain was clearly not managed, so perhaps a debrief will help you through that as it’s hideous being in post surgical pain and sadly, sometimes pain cannot be well controlled.

I’m wondering what good a debrief would be though.

So someone unrelated to the care can go through the notes. The OP can go through what she remembers and the supervisor of midwives (or whoever does the debrief) can see where there are discrepancies, talk about what the likely scenario was and whether what the OP remembers was even possible, then carry out an investigation if the OP is still not satisfied.

If a midwife is genuinely stealing and using that level of oramorph whilst she is working, as the OP states, she will have an addiction that means she is stealing so much that it cannot be concealed because the stocks will show a huge discrepancy.

Everything @AnyOldPrion said. I doubt she was stealing your meds. But there is a real issue here that they downplayed your pain, didn't consider the major and traumatic surgery you had and accused you of drug addiction and threatened you with SS, rather than the more obvious explanation that you were confused on strong painkillers, traumatised and in extreme pain. And tried to put it down to mental health. Because, you know, any woman confused and distressed after major surgery with complications on opiates must be mentally ill right?
This kind of under playing of pain is rife in women's healthcare and absolutely should be complained about.

I'm a nurse. 20ml or Oramorph sounds a huge dose to give an opiate naive patient. 5ml -10ml would be the Max we would give.

@OnlineShopping that’s surely not the right process to launch an investigation/ complaint though?

When I had my debrief I had to sign something beforehand to say I wasn’t looking to make a compliant / claim against the hospital. Presumably because they’d potentially incriminate themselves. If OP wants an investigation she has to find out the correct process

Post op oramorph didn’t really help me. I believe if you are feeling or being sick or your digestion is slowed down it’s absorption isn’t that reliable.
On the other hand IV paracetamol really made a difference, even though it was the same dose as you would get over the counter. Just giving you more morphine wouldn’t necessarily help but could increase the side effects.

I was on alternating paracetamol & oramorph every 2 hours as they wouldn’t give me either more frequently could that have been what you saw on your chart?

Oramorph is still a controlled drug on my unit.

The fact that you are comparing the volume of subcutaneous morphine and oramorph tells us all we need to know. You need a debrief because you clearly don't understand.

@Passthecherrycoke no, I doubt it is the right way but I would imagine that after the debrief the OP will realise that there isn’t a complaint to be made but at least she will have the information in front of her and will understand that. A proper complaint goes via PALS.

You spent a great deal of time in pain. There are several possible causes for this

• the drug not working for you
• the nurse not administering the right dosage
• the nurse not administering often enough
• the dr not perscribing the right dosage

None of us here can tell you what happened. The first step is for you to get a debrief.

It's not unheard of for HCPs to steal medication. Nor is it unheard of for patients in a lot of pain to be confused. Nor is it unheard of for drugs not to work on all patients. All of these senarios are possible.

@Span1elsRock I have waist length hair of about 10 years growth which would prove no drug use in the last decade at least.
I'm not sure what's suspicious about checking strong medication before taking it - id never blindly take anything without checking its the correct amount, no matter who gave it me.
I was happy to take 5ml, until it didnt manage the pain, and I wasn't given the higher dose I'd been given the green light to have. Which was then misrecorded.

@Morphinemidwife but did the prescribed dose later appear after that HCP left shift? That's your answer.

Nobody would ever give even 10ml every 2 hours.

@MacabreMannequinFun re-read, I have not once compared sub cut and oral dose.

I did not know subcut dose as was literally as I was coming around.

Pump dose was 1mg per press.

OP, are you aware you believe you were prescribed double the maximum daily dose of morphine? Logically, does that sound right to you?

@sanmiguel that’s exactly what I’m struggling with. If it was the night shift (and the same night shift HCP all week?) stealing drugs the normal dose should’ve resumed during the day. It doesn’t make sense that OP would be prescribed a maximum dose overnight and nothing during the day, oramorph wears off fairly quickly

@sanmiguel no, as explained earlier. After threats of SS and mental health team involvement I was scared to ask again so was just in pain.

When the shift swapped in the morning I was told I'd had an incredibly high dose that obviously wasn't working so I couldn't have anymore. I asked for alternate pain relief, and got none, other than the continuation of paracetanol

But did they tell you that every morning for 5 days?

@Passthecherrycoke because of what was recorded on my chart I was believed to have had the max dose so was given no more on shift change. Obviously the 15ml/30mg I had is not actually the maximum daily dose, but they believed id had 120mg, which is

@Passthecherrycoke I wasn't going to ask for it again after all the crap being accused of substance abuse before.
I asked for alternative pain relief, got none. Was never offered oramorph again.

@Passthecherrycoke exactly. If you're in hospital 5 days you'd surely notice the discrepancies across a staffing group. I'm not disputing the possibility of stealing the drugs or staff being exhausted and making an error (as I witnessed it with my fil who was gives over his prescribed drug and which the doctor had to come and disclose and explain to us). But, having had the pain of a section and having experienced the head fuck of morphine, I'm inclined to think this is a case of someone feeling overwhelmed and later pointing the finger at a tired HCP.

But you’re saying you were prescribed the maximum dose, administered in the 12 hours overnight, and the nurse didn’t give it to you. But you still believe you were supposed to have it

How would you have managed pain for the rest of the day if you were supposed to have the maximum dose in 24 hours overnight? It doesn’t make sense

Definitely go for a debrief OP.

When I gave birth 3 months ago I was prescribed liquid morphine by the anaesthetist. I can’t remember the dose or the frequency but I do distinctly remember that it was dispensed by TWO midwives, who cross-checked the drugs and dose with the chart and each other before giving it to me, and who were both wearing apron things saying something like ‘drugs round in process, do not interrupt’.

Accusing patients of being drug addicts because staff have failed to provide appropriate pain relief post surgery is the bigger issue here. That should not be happening to people.