Our hospital created new order sets to be compliant with all of the new JCAHO patient safety mandates.
One of the JCAHO requirements is that pain medications must be administered according to a patient’s rated pain scale. If a patient complains of pain of “3″ they get one medication whereas if they complain of pain of “7″ they may need another medication.
So the order for pain medications on the order set reads “Administer [chosen pain medication] [chosen dosage] intramuscularly/intravenously every ___ hours for pain rated as _______.”
While writing admission orders for a patient, I just decided to write “administer morphine 5mg intravenously every 4 hours for pain rated as 2.17 or greater.”
The patient went upstairs to the floor. I forgot about her amongst the multiple other admits throughout the evening.
The following morning as my shift was ending, I get a visit from the president of the medical staff.
“You know that patient you sent upstairs last night … Mrs. Smith?”
Those are words that usually mean something bad happened.
“Yeah …” I said hesitantly.
“Well there was a big problem with her orders.”
“What’s with the pain rating of ’2.17′? The secretary didn’t know how to enter it into the system. She called the nurse. The nurse didn’t know how to interpret it. She called the nursing supervisor. The supervisor had never seen someone enter a pain scale like that, so she called me – the attending – at 4 AM to clarify your order.”
“You’re kidding me.”
“No. But I kind of laughed, though. I’m actually surprised that no one has done that before. I just wanted you to know that you had the whole medical floor up in arms with that order.”
“Great. Sorry about that.”
Next time I’m going to write for medications when a patient rates their pain as “π” or above.
Then again, the symbol for “pi” looks too much like a Roman numeral “II” which could cause people to get pain medication when they rate their pain as a 2 instead of when they rate their pain as a 3.1415 or higher. That could result in patients getting pain medication for a rating 1.1415 points sooner than they actually need that pain medication and could compromise patient safety.
I will therefore write out the word “pi” when making this entry.
Then again, a sloppily written “pi” could look like the number “61″ which could make it so that some patient has to complain of pain of 61 or greater in order to receive pain medication. That could leave patients in pain and could compromise patient safety.
Or the “pi” could look like a “pl” which might be mistaken for a shorthand form of “please” so that a patient could be given pain medications for any pain rating in which they say “please.” That could result in overmedication and could compromise patient safety.
I think I see another patient safety mandate on the horizon.