Giving narcotics to patients with no ride

rjflyn, ASN, RN · Mar 5, 2012

This is one of those slippery slope issues that has been discussed on numerous occasions. The long and short of it is one needs to follow appropriate policy and procedures while providing appropriate care.

rndiver82 · Mar 6, 2012

If the patient had no ride, we would not give narcotics. The liability is just too high. We would give the patient anti-emetics and make sure those were working then give them a script for pain meds to take at home.It was that or they were admitted to the hospital for pain management. If they were admitted, got the meds and then left AMA, the admitting doctor would actually call police to let them know about an impaired driver. Because they were now a public safety hazard, the doctor was much more willing to risk a privacy issue than a medical malpractice lawsuit if that patient got into an accident and maimed or killed someone.

nuangel1, BSN, RN · Mar 6, 2012

we don't give narcotics if pt doesnot have a ride .this id discussed with the pt prior to meds being given.we would treat him with non narcotics ivf and antiemetics.the provider would d/c on what pt would get as scripts on d/c.

LaughingRN · Mar 6, 2012

Slippery slope indeed. Most of the time in the ER, oders for heavy duty pain meds come before a dispo.

Do you withold pain meds to the suspected dissecting aorta, to the multiple stab wound patient in trauma, to the patient with a decent fracture of a long bone in the body because they may not have a ride home?

All these patients may go home without being admitted if their tests come back fine and they don't require a trip to the OR.

But, in the moment, you don't know that.

I medicate first, and if needed in the end, refer them for a cab voucher at patient services.

I can already hear the echo of arguments forming "what if they don't take the voucher and just drive?"

I am a nurse. Not a god, and not ownership of other people's choices. I don't have an answer for the what if's. I can't micro- manage the choices of others.

I can treat pain, educate on the risks of driving, and provide an alternative.

I am only one person.

BrnEyedGirl, BSN, MSN, RN, APRN · Mar 6, 2012

I have to actually see the person who is driving before I give narcs. It is our hospital policy. We have had pts who lie or suddenly their ride is gone, security watches these pts and they notify local law enforcement. The pts are told this ahead of time.

vanburbian · Mar 6, 2012

Majority of my pt.'s are homeless, and we send them out walking. Otherwise, the insured visitors generally have someone they can call, or we make them call a cab, or if we know they are driving we don't narc 'em.

brainkandy87 · Mar 7, 2012

We have a list of cabs that we call if they don't have a ride. Our ER is pretty good about finding them a way home if they came in alone. We don't want to withhold pain medication from them if they really do need it.

nurse2033, MSN, RN · Mar 7, 2012

You don't get narcs if you don't have a ride. If you can't take it, you can opt to be admitted for pain management. You can't responsibly let a patient under the influence of drugs leave and drive. As others mentioned, this is discussed with the patient and a sort of verbal contract, or understanding, established first.

rjflyn, ASN, RN · Mar 8, 2012

I wanna work where you can afford/have cab vouchers, I as the supervisor would spend my whole night writing them.

Having said that there is even liability in putting someone in a cab after narcs. Whats to say once said cab leaves the guy just doesn't get out around the corner. A bus is no better option- he could get hit as he steps off. Worse is " oh I just withhold narcs if they dont have a ride", is that policy or is that you now practicing without a license.

The best option is a comprehensive policy that allows for prompt care, puts the decision in the hands of the practitioner and gives you an options if the patient breaks the rules. When in doubt, ask the provider, your charge person and goodness talk to your patients.

obgoddess · Mar 10, 2012

We keep them for four hours after any narcotics if they dont have a ride. They dont get their discharge papers if we dont see their ride on the unit. We also have cab vouchers we use.

Esme12, ASN, BSN, RN · Mar 10, 2012

Slippery slope indeed. Most of the time in the ER, oders for heavy duty pain meds come before a dispo.
Do you withold pain meds to the suspected dissecting aorta, to the multiple stab wound patient in trauma, to the patient with a decent fracture of a long bone in the body because they may not have a ride home?
All these patients may go home without being admitted if their tests come back fine and they don't require a trip to the OR.
But, in the moment, you don't know that.
I medicate first, and if needed in the end, refer them for a cab voucher at patient services.
I can already hear the echo of arguments forming "what if they don't take the voucher and just drive?"
I am a nurse. Not a god, and not ownership of other people's choices. I don't have an answer for the what if's. I can't micro- manage the choices of others.
I can treat pain, educate on the risks of driving, and provide an alternative.
I am only one person.

It depends on where you work. It depends on hospital policy. It depends on the local police. Multiple stab wounds usually are admitted OBS and suspected aortas go to al least tele.

I have worked at places that waited an hour or 2 and let them go, I have worked at places that waited 4. I have worked a places that called for a cab and used vouchers. I have worked for places that refuse to voucher anyone and call the police to PC. Personally it depends on the situation and presentation in my decision making process.

This has been discussed at length here.....

Google Search Results for giving narcs no ride home Try here. :)