Case Study: Medication for Pain and Symptom Relief
Peter is an 82-year-old resident of the Summer Gardens Residential Aged Care Facility with end stage lung cancer. The cancer has spread to the bones in Peter’s chest and spine, causing pain and discomfort. His doctors have told him he may not have much longer to live. He no longer feels like eating, and has asked the staff to stop bringing him food and water.
On Friday, during his GP’s routine visit to the facility, Peter complains to him that he has severe back pain and difficulty breathing. The GP determines the current regular dosage of oral morphine is no longer effective, and writes in Peter’s Care Plan that the dosage be increased. He also notes that Peter can receive prn morphine, to keep Peter comfortable. The GP rings Peter’s son and tells him that Peter’s condition is deteriorating and his life expectancy is quite short, perhaps only a few days, or perhaps a week or so.
On Saturday morning Anna, a Registered Nurse at the Facility, is on duty. She is asked to give some of the residents their medication. When Anna visits Peter he is coughing a lot and struggling to breathe. He is able to indicate he also has increased pain. She gives Peter his regular medication, and a prn dose of oral morphine.
In the early evening when Anna checks on Peter he tells Anna ‘I’m in agony here’ and complains of excruciating back and chest pain. After assessing his pain and breathlessness, Anna decides to give a further dose of prn oral morphine to reduce his discomfort. Peter dozes off while she is leaving his room. Anna finished her shift and heads home.
In the early hours of Sunday morning, Peter is found by a care worker to have died in his sleep. Anna learns of Peter’s death later that day when she starts her next shift. She is very worried that the additional prn dose of medication she gave him might have had something to do with him dying, and that she will get into trouble. She decides to talk to her manager.
On Monday Anna meets with her manager and tells her about the medication she gave to Peter in his final hours. Her manager advises her that she has done nothing wrong. Anna did not intend for Peter’s death to be hastened; rather, she gave the regular and prn medications to Peter to relieve his pain and breathlessness in accordance with the GP’s instructions. The law would recognise this as appropriate palliative care.