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Can a doctor change a new resident's meds without seeing her?

My mother just moved into a memory care facility. They promised that the staff doctor would write new scripts for the meds she's been taking, including 500mg tylenol. Instead the next day he prescribed morphine as needed without ever seeing her. She never complained of pain at her previous facility, while taking 500 mg tylenol 4 times a day for minor arthritis pain. I'm afraid she will become zombie-like. The other patients don't smile, and in fact, barely speak. Am I right to be concerned?
Status: Open    Oct 13, 2015 - 07:16 AM

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Expert Answers

Nov 02, 2015 - 12:27 PM

I encountered a similar situation, when I was POA for my elderly cousin. Sometimes facilities have routine orders for residents upon admission. The morphine may have been ordered just in case your mother did have some pain, Morphine is not a drug of choice for arthritis. It may be that someone forgot to order something for her arthritis. I would suggest that you set up meetings with the charge nurse and the doctor. Phone conversations are good, but face to face meetings are most effective. Those meetings are even better if your mother is able to be present, depending upon her condition. When you meet with the nurse, you should not only discuss your mother’s medications but also other aspects of her care, including activity, bathing and diet. You can provide insights about your mother that can help them individualize her care. Your meeting with the doctor will help you get your questions answered about the doctor’s plan of care for your mother. If you still have concerns, does the facility allow another physician to see your mother? I found that once I made contact with the nurses and doctors, they got in contact with me when they were considering changes in my cousin’s plan of care. It also helps if you or other family members can make frequent visits to see your mother and monitor her care.
I wish you and your mother luck in her adjustment to the new facility.



Oct 13, 2015 - 02:52 PM

Can a physician change medications without seeing a resident? Yes; however, there are liability issues for the physician if the medication is a scheduled drug (morphine is schedule II). Should they is another question. The answer is NO! Yes, you have reason to be concerned!

The physician should continue her current medications until the physician has examined the patient (in this case, your mother). The physician can at that time make appropriate changes. In as much as the morphine was prescribed "as needed", i cant imagine an astute nursing staff would give it.

Morphine for mild, non terminal pain is not an appropriate medication and you can ask the facility medical director or pharmacy consultant to review your mom's medications and discuss it with the prescribing physician.

You also need to discuss this with the director of nursing in the presence of the facility administrator. Both need to be aware that the physician is making these changes without examining the patient.

The state Board of pharmacy would have issues with prescribing morphine sight unseen, unless the patient is in a hospice program (which I am assuming is not the case here).

Dr. Gerry Lane
Retired geriatric physician

Oct 14, 2015 - 04:52 PM

I am guessing that the Charge Nurse requested a pain med, which is often the case in a memory care facility. The licensed staff nurse has made an assessment and if the patient shows acute pain during assessment, or complains of pain that interfers with mobility or ADLs, she/he can request a pain med more than Tylenol, based on their professional judgement and assessment. It is within their practice, and appropriate to report the pain and to request a pain med from the doctor. Morphine is usually the doctor's call and it isn't unusual because it has fewer side effects and is short-acting (as prn).

You want your mother to be comfortable and free of pain and you have entrusted her to a memory care facility. Talk to the staff about your concerns and they will most definitely address your concerns.

Retired RN, Long-term care
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