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I did not want my mother, who was in terrible pain, and agitated, to die in that state. I wanted her to die peacefully. Because she WAS dying. She had dementia, chronic heart failure, had fallen, broken her wrist, smashed up her face and developed pneumonia, which was treated with antibiotics. She wouldn't get out of bed and lay there with her face screwed up in pain and horror. Doubling her regular pain meds did not help. Morphine eased her breathing and restored her calm.
If she was meant to heal and live, taking away her pain would have helped. She died, but not because of morphine.
Here it is again;
"""Other experts recommend consulting a pain management specialist ""BEFORE"" exceeding a dosage of 80–120 mg daily."""""
This means you CAN exceed this doseage but should be done under a pain specialist's (MD) watchful eye.
I can only speak for the hospice I work for. We do NOT give huge doses to our patients with severe pain. The dose is "titrated" to keep the patient comfortable-not comatose!
If it takes giving them meds every hour, then that's what we do. But not in ridiculous doses.
I had a patient who was 55 years old, (younger than me 😢) dying from cancer. Her partner had witnessed her parents die in pain and told me to keep her out of pain. When I had given her everything I could and she was STILL writhing, I called the doctor. I got new orders for medications. The Sig Other wanted me to keep giving her more but I explained medication takes a few minutes to be absorbed. If after 15 minutes, she's still restless, I'd give her more.
OUR GOAL IS TO RELIEVE PAIN AND ANXIETY.
She calmed down and was able to rest with slow, easy breathing. Her SIg. Other sat with her for a couple of hours and was relieved that she was finally comfortable. The patient died many hours later that day. The spouse was immensely grateful that she didn't thrash around suffering in her last hours.
I did not kill her-cancer killed her. I made her as comfortable as I could with the little time she had left.
I'm not saying every hospice is perfect-far from. But to clump ALL hospices in the "killer" catagory is wrong. We provide a needed service to the dying and their families.
You should be using your talents to tell folks who are watching their loved ones die that they should prolong the suffering, don't you think? Really, you might extend a few days of agony for everyone, which I think is what you want.
Let the doctors try that experimental treatment that might give mom another week. Force them to do another round of chemo, another round of injections, another lung tap.
That's the natural way to die, right?
Sue what you copied and pasted, warns against exceeding 90mg to 120mg DAILY.
"Nurses gave high doses of drugs such as morphine, regardless of whether patients needed it, to justify the higher payments, prosecutors said. In some instances, these excessive dosages resulted in serious bodily injury or death."
dallasnews.com /news/frisco/2017/02/28/frisco-man-15-others-indicted-medicare-hospice-scheme-used-human-life-vulnerable-stage
Just the tip of the iceberg. I hope they all get caught.
I tried to access the BMF website but I couldn't find a way to look up anything. (?)
This is from drugs.com;
"CDC (Center for Disease Control) states that primary care clinicians should carefully reassess individual benefits and risks before prescribing morphine sulfate dosages ≥50 mg daily for chronic pain and should avoid dosages ≥90 mg daily or carefully justify decision to prescribe such dosages. Other experts recommend consulting a pain management specialist before exceeding a dosage of 80–120 mg daily."
I understand patients developing a tolerance to opioids but I have NEVER seen 300 mg. of Morphine being given AT ONCE. I would bet you a weeks pay that there never was an order that said to give 300mg. at once.
You wrote 30 mg. every 4 hrs., up to 200 mg. every 4 hours (or 50 mg./hr.)
Then;
100 mg. every 12 hours, up to 600 mg. every 12 hours. (or 50 mg. hr)
for a maximum dose of 1200 mg. in a 24 hour period.
I think you'd be hard pressed to find that amount being given in most hospices or written by most doctors.
At the hospice where I work, our orders;
Give Morphine 15 mg. every four hours.
For "breakthrough" pain, give Morphine 5-10 mg. every hour as needed.
Let's suppose the patient needed breakthrough pain medicine (Morphine 10 mg.) EVERY hour.
Morphine 15 mg. given 6 times in a 24 hour period plus Morphine 10 mg. given 18 times in a 24 hour period.
90+180=270 mg. for a 24 hour period.
I'm not saying huge doses can't and don't happen, but I think it's a lot less common than the lower doses.
I'm only one person working with one hospice. I have worked more than 2 decades in acute care hospitals.
If this is happening, it flew past me. 🕊
P.S. Vicodin is prescribed for moderate pain. It contains 300 mg. Acetaminophen (Tylenol) and therefore can't be given after the acetaminophen doseage has gone over 2 Gm./day or liver toxicity could result. The dose instructions are to take one tablet every 6 hours, not to exceed 6 tablets in 24 hours.
Is that going to be sufficient to relieve pain in a dying person? I doubt it.
So I looked it up and found this in the BNF:
Pain in palliative care (following initial titration)
By mouth using immediate-release medicines
For Adult
Usual dose 30 mg every 4 hours; up to 200 mg every 4 hours, higher dose may be required for some patients (occasionally more is needed); for management of breakthrough pain and other general advice, see Pain management with opioids under "Prescribing in palliative care".
By mouth using modified-release medicines
For Adult
Usual dose 100 mg every 12 hours; up to 600 mg every 12 hours, higher dose may be required for some patients (occasionally more is needed); for management of breakthrough pain and other general advice, see Pain management with opioids under "Prescribing in palliative care".
It sounds as though there was maybe some kind of reaction to the morphine itself? - if her pain was uncontrollable in spite of the increased dose, but then able to be controlled with Vicodin instead.
But then isn't that the point anyway? That hospice are not death squads who, once you invite them over the threshold, will kill your loved one come what may. Mamacat decided on a second opinion on her sister's behalf. I'm very glad, good catch, good outcome. That's what's *supposed* to happen.
What you witnessed was real and is happening widespread, in every state.
I recommend the Hospice Patients Alliance. It is a pro-life, patient advocate organization. It was founded by a hospice nurse, turned whistleblower. He saw these things happening and couldn't take it anymore.
Their website is filled with information and first hand accounts that could answer many of your questions.
You can email them, tell them your story and ask questions.
They also have a phone number you can call to get help and advice.
It is one of the best resources for these issues.
I'll play along just so some new innocent poster doesn't really believe your crock of cr*p.
*She received 300 mg. of Morphine.
•Again, there is and never has been a doseage of Morphine that is 300mg. That would cause death instantly. Like I've said, the doses vary from 5-15 mg.
*They were trying to get her off hospice because after 6 months, they loose money on her.
•Wrong again. The Medicare program (federal government) funds hospice. Some patients have been on hospice for years. If they improve (which occasionally is the case), they come off. If they need pain management, nausea/vomiting control or breathing assistance or anxiety control, we can put them back on hospice.
* Vicodan is controlling her pain where Morphine didn't?
• Wow, that's ridiculous. Morphine is much stronger than Vicodan. And Vicodan has Acetaminophen (Tylenol) in it, so the patient would receive too much of the Tylenol in trying to get rid of the pain.
I think this thread, like the other anti-hospice thread, should be put to sleep.
Let's give it 300 mg. of Morphine! 😝 💉
I think "prolife" is making multiple personalities up, or else calling in other activist friends to invade the forum with their b.s. Maybe both.
Hospice called you in to make funeral arrangements? Here in my area, Hospice is only responsible for having the telephone number for the funeral home for when, and if, the patient passes. Hospice needs to know whom to call.
I know during this time everything is highly emotionally charged. Family members are like deer in headlights, and not processing everything that the doctor and nurses are saying. It can be easy to get facts mixed up.
I'm sorry your daughter was sick. You say she is alive 3 YEARS later? Sounds like her doctor misdiagnosed her having a terminal illness and the length of time she had left to live. (In order to enter hospice, the patient is terminal and has around 6 months to live.)
I believe you have your mg. strength wrong on the Morphine. There is no way someone could be alive after receiving a 300 mg. dose. Maybe she was on 30mg.? Even that is a very large dose UNLESS she had been taking
Morphine for a long time and had built up a tolerance to it.
Usually antibiotics would not be given because it would be considered a "lifesaving" measure (hospice is for the dying) but Tylenol definitely could be given for the patients comfort.
I'm glad that she survived.
Curious, why did you place your daughter on Hospice, you mentioned she was in pain? It is not unusual for a patient to graduated from Hospice to continue to live more months or even years.
Chances are the dosage was more like 5mg to 15 mg. The amount is no different than what is given to hospital patients who have had surgery. I have had 2 major surgeries where I was given a morphine pump for the pain.
Make sure your daughter has a legal document stating that she refuses to have Hospice, and refuses to have Morphine should she need surgery. Make sure it is signed, dated, and Notarized. And have one drawn up for yourself.
A drunk caregiver that robbed his cash, gave meds early, force fed a sleeping patient....wow. Was no one observing what was going on with him?
FYI,
1 mg. of Morphine wouldn't be enough to even be felt, let alone kill anyone. I normally give between 5-15 mg. every 4 hours with my hospice patients.
Then there's the" Burger King Double Whopper with fries" cocktail.
Scary stuff people! The subliminal messages in the ads "buy us", "eat us"........." stuff your face with us." Scary. Close your eyes, plug your ears boys and girls.
Sorry,............couldn't resist.
I doubt that this poster really wanted answers-only to stir up **it,
just like the other insane anti-hospice thread.
Some have called them trolls.
You clearly had a bad hospice team. It is NOT the norm to ask family membets to leave. I hope you reported this. If not, DO IT NOW!!!