How do you handle the drug seekers?

[itsnowornever]

Ok, disclaimer---37 days left of school for me, but have some nagging questions.

During my ED round we had a female patient who was a drug seeker. Complaining of abdominal pain when no cause was found. Dr did every work up imaginable and was quite patient with her. Problem? She brought her 8 year old daughter into the ED with her and every 10 min her daughter would come to the nursing station and say, "My mom needs her nurse" or "My mom is in pain, can she have medication?" finally, after repeatedly tending to the mom (I wasn't her nurse, but I have kids, so I felt bad for this kid) and escorting the daughter back to the room the daughter came out, put her hands on her hips and said, "My mom is in pain, we have been here for hours and you are doing NOTHING for her"...to make this trip the daughter was nearly run over by paramedics pushing a gurney, a tech pushing a tall cart with linens and nearly tripped a few nurses carrying meds or food. I finally blew a gaskit and sternly explained to the little girl she could NOT come out of that room or she would get hurt by someone pushing something. I took her back to her mom and sternly explained that mom has a call button, she can call her nurse if she needs something but she needed to stop sending her daughter out or her daughter may actually get hit by something or hurt someone else on accident. Mom started to argue with me and say, "I am not sending her out" at this point I turned around and left, found the nurse and told him what happened. Found the DR and told him what happened (he was a cool Dr and was already aware that she was a drug seeker). Mom was a piece of work, let me tell y

In school we are repeatedly told, "pain is what the patients say it is" BUT on the floor, all she got was motrin and she was sent home with motrin. She stated pain was 10/10, but I guess in a students mind motrin doesn't cover 10/10. I'm ok with what was done for the mom (she was there about 10 hours total.)

What do you guys do in this situation? I'm more concerned about the kid. Was I wrong? No one said I was. No one said anything bad about what I did, I"m just curious. And I feel so bad for this little girl. She may grow up thinking medical personnel are horrible people if this is what mom does to her.

[NO50FRANNY]

That EXACT sentence, the sentence that includes how many hours they have been waiting and the villification "you haven't done anything and she is in pain!" comes out of the mouths of 95% of the narcotic seekers that I attempt to care for when they are getting impatient and suspect we are onto them. The last lady who tried that one, loudly and in front of other patients, got told to get her facts straight (just as loudly), she had been given an orificenal of PO analgesia and seen a doctor, had a bag of fluid. I think the wording is designed for others to hear, makes us feel guilty, and make us look bad, it's part of the strategy to involve other patients / family (my least favourite one). We are NOT obliged to start first line with opiate/narcotic medication, there are plenty of other analgesics. Always investigate and always provide pain relief, but I agree with BrainKandy's summary and couldn't say it better myself. Did the patient or her daughter express concern about what might be wrong or was it all about the pain?. Narcotic seekers are rarely interested in having a diagnosis or investigations and are usually just fixated on medication. You will see a lot of people seeking one form of medicine or another in ED, and eventually become an expert at spotting the behaviours, they are essentially all they same, some are just a little more clever than others and involving family members is common. I think you did the right thing.:)

[itsnowornever, BSN, RN]

NO50FRANNY--she didn't say ANYTHING about what she thought the problem was. The doc even did a pelvic to see if he could see the problem that way...during the pelvic her bored child was asking questions like "What is that thing with the light" "What are you doing" and "Why can't I see what you are doing" during this time the mom was fine enough to start swatting in the direction of her child telling her to be quiet and not ask questions. I should also add that the mother during these 10 hours would start WAILING and CRYING if no one had come to see her in what she considered "A long time". *SIGH*....I'm sure this was just my first time of many at this rodeo.

[Wishinonastar, BSN]

Glad to see that there are some out there who remain professional about this. Pain is not visible like bleeding. We cannot be judges of another's pain. I also had a patient with persistant abdominal pain and no diagnosis for a long time. It turned out to be diabetes mellitus, affecting the vessels in her bowel. She was very sick and a lot of people thought she was drug seeking before they figured it out.

I think ER personnel do see the repeat offenders a lot, but then again who can judge another's pain? At least they can medicate and send them home. The difficulty lies more with the PCP who really has to get to the bottom of things.

If this woman was in there for 10 hours and only got motrin, chances are she will give up on the ER if she is truly seeking drugs. If not, then I feel very sorry for her for having such an awful experience.

I myself am going through post-herpetic neuralgia and I will tell you it is agonizing. The insurance company will not pay for lidocaine patches and they told me to go to the ER. HA! No way. I took OTC lidocaine cream, put it on a large bandaid, and made my own patches. Not as effective but better than nothing. Lord knows I do not want to deal with bitter nurses thinking I am drug seeking. I would rather burn the nerve with a soldering iron, an idea that I actually toyed with at one point because of the pain.

[Maseca]

I haven't started nursing school yet (one month!), but this story sounds very familiar to me. I was that little girl when I was a child. My mother has had addictions to pain medication most of my life, and as a result, I ended up being the parent in the situation. When we would go to the hospital, and I would be the one to try and get "help" for my mom, mostly because I really wanted to go back home and sleep. I could go on, but needless to say, that little girl was being forced to take on concerns and responsibilities far beyond her years

I know your time with patients is limited in the ER, but what can be done for the kids in that situation? Would it have been appropriate to tell her in some way that she doesn't need to be responsible for her mom, that the doctors and nurses were taking care of everything? Could some sort of intervention be done to help the children who are forced into a caretaking role due to their parent's addictions? What can the nurse's role be in that aspect?

[ncaiazzo]

We actually had this circumstance, we reported it to children and youth. Who is taking care of the chld when Mom is strung out on drugs? And where did Mom think she was going when she left the room unsupervised in a busy ED? She is using the child to support her drug habit and if she was ignorant of the child's behavior, why did she bring her in the first place. By law suspected circumstances of child abuse must be reported. The investigation should remove or improve this child's environment.

[mrstmarie]

You know some people will go to crazy extremes for pain meds. I worked in a very rural/small 1 room ER. We didn't have a CT, just the old film xray. Anyway this guy would come in crying, balled up, c/o severe abdominal pain. All the signs of kidney stones. We'd do a UA and he be positive for blood, xray never would show anything, and Doc would medicate appropriately. So this happened several times until one time a guard from the jail he was incarcerated in caught him sticking a toothpick in the tip of his member causing trauma resulting in *blood in the urine* Amazing

[CrunchRN, ADN, RN]

Isn't up to the MD anyway? What can you do but follow orders and duct tape the kid onto a chair?

[nurseprnRN, BSN, RN]

"what can you do but follow orders"?

this is a joke, albeit in really poor taste, right?

[CrunchRN, ADN, RN]

"what can you do but follow orders"?

this is a joke, albeit in really poor taste, right?

sort of...............................

[kbucksn]

I totally agree with what your saying. Things should be taken a step further and other visits checked. Your right if this is the 3rd time this week or they come in a few times a week or whatever for the last few months, etc than RED FLAG. But, i still think as another poster had said, at that point instead of writing someone off that is a flag that they have a need not being met. Whether that means they are not taking care of that "dental pain" for example, we need to find out why not?? No insurance,etc?? Offer referrals or a social worker to help them with such. But I DO believe we need to try to address patients a bit more holistically.

[kbucksn]

The only thing about that is what if you are making these accusations that "Mom is strung out on drugs" and you are wrong? What if like nursemarion's pt there is a REAL illness and REAL pain going on, now we have just introduced a whole bunch of stress and crap into someone's life unnecessarily. Maybe Mom has nobody to watch said child? I just don't think assuming Mom is using child to support her drug habit based upon the few minutes one spend with the pt is quite right either. Maybe Mom didn't realize she went out there because she is sick and in real pain???

[nurse2033, MSN, RN]

That kid has a bad parent but there's nothing you can do about it, it's sad. As for the patient we usually give a reasonable dose of pain medication, say 2 doses of 1mg of dilaudid. A dose that would normally help a person that is not a habitual user. It's up to the doctor to explain to the patient why they can't have more. As another poster noted, in my state we have a registry of prescriptions so they can check how many and what drugs they have been taking. It is not uncommon for patients to be taking huge amounts of oxy. So, the normal dose does them no good, but shows the MD is treating them. However, the basic problem remains, that if the patient is in pain, you try to treat them. You can't cure them or treat them for their underlying problem in an ER setting. It is unethical to deny pain meds because you "believe" they are faking. Our health care system is set up to favor the patient and we can't change that in one shift.