Palliative care team vs Doctor..

RolandFlagg

That title is probably not the best way to describe the situation but here goes.

My Mam is in a nursing home. She is as terminal lung cancer and is on an oxygen concentrator machine 24/7.
Meds wise she was getting a time release morphine table 9am and 9pm.

In between liquid morphine 4 time a day, and a injection of morphine into the skin for an instant hit when the pain get's really bad.

Late Friday a Doctor came to visit and took it upon herself to double the dose of the tablets, but half the dose of the liquid morphine, and totally removed the option of an injectable.

Yesterday my Mam was in horrendous pain. The increase in tablet dose did nothing, and the reduction in everything else meant she had to stay in pain with the nurses at home saying their hands were tied because of what the doctor had ordered.

I managed to get in touch with the regional head Palliative Nurse, who went mad, phoned the home and told them to put everything back the way it was.
The nurse on duty did this, give my Mam an injection, which eased her pain.

Problem is, there was a change of shift, and a new nurse came on who said that the doctors orders over rode the Palliative Nurses.

Hopefully all this will be resolved tomorrow with the Palliative Team is coming in, but I don't want to see my Mam in pain today.

So who is right? Does the Doctor or Palliative Team have the final say in my Mam meds?

elsien

I’m so sorry that your mum is in this situation.
I want to start by saying that t don’t know the answer but wanted to share some information. 

Generally in a care home it is the GP who is the person in charge of the day to day health care needs. However with regards to end of life care, the NICE guidance refers to a lead professional which can be either GP or a senior nurse, and talks about communication between them.

https://www.nice.org.uk/guidance/ng142/chapter/Recommendations#providing-multipractitioner-care

Can the care home not call the out of hours GP service to tell them how much pain she is in, and what the palliative care team have said if the nurse on shift wants to cover herself? Regardless of who is in charge, the care home has a responsibility to follow up if she is in that level of pain. 

Maskface

In my case it was the opposite. Mum only had weeks to live but the palliative care team were faffing around lowering meds because they were worried she'd become dependent on morphine while the doctor was saying look, she's dying does it really matter if she develops a habit? And increasing it back up. 

I think perhaps ask for a different doctor and tell them you don't want that one treating your mum, you have that right. Keep calling the nurses and insisting your mum needs more pain relief until they listen and insist on speaking to the doctor. But make it clear that's not the doctor who interfered.

kezzygirl

I can see why they might have increased slow release morphine,to try and reduce the amount of (I assume) prn-as and when-liquid morphine so effectively your mother should have better cover in terms of pain relief with the slow release tablet. That said, the liquid morphine would probably have to be reduced if her max dose of tablet form was reaching near bnf limits-they don't want to overdose her as it could be lethal. Perhaps call the gp and ask for justification as to why they have done what they have done- they should be happy to discuss with you to clarify things.