Q: Our hospice provides clinical experiences for senior level BSN students from our local university. I enjoy working with students, so I volunteered to serve as a preceptor. Last week, one of the BSN students accompanied me to the hospital for an admission. While we were reviewing the patient's medication record, the student was surprised to see that a patient with advanced lung cancer was receiving promethazine HCL (Phenergan) with an opioid for pain. Before I had an opportunity to answer, one of the RNs on the unit said, "Phenergan potentiates opioid analgesics." I knew that is not true-and politely said so-but I didn't have any supporting evidence. I told them I would follow up on the issue. Can you help me?

-Hospice RN and Clinical Preceptor

A: Your question illustrates how hard it is to debunk myths and change clinical practice. The results of a survey evaluating nurses' knowledge and attitudes about pain management were recently published in Nursing 2002.1 There were 3169 survey respondents so the results do represent the current state of knowledge among nurses. In particular, one true/false question asked: "Research shows that promethazine HCL (Phenergan) reliably potentiates opioid analgesics." The correct answer is "False" but only 35.1% of the respondents (n = 1,111) answered the question correctly.

According to Robinson and McCaffrey, 1 research demonstrates that promethazine neither relieves pain nor potentiates opioid analgesia. Promethazine is very sedating and therefore limits the amounts of opioids that can be used safely for pain relief. Sedation can be confused with pain relief. Refer other healthcare providers to research-based clinical practice guidelines that address this issue. In 1999 the American Pain Society (APS) 2 published their document that Okay 1

McCaffrey and Pasero have written an excellent book on pain management. 3 You might suggest this as a reference for the unit and for your hospice.

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