How do you handle the drug seekers? - page 3
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... Read More
2Jul 19, '12 by NO50FRANNY[QUOTE=billyboblewis;6722705]I am a RN with 45 years experience, 40 as an RN. I am truly upset by the atitude you get when you go to the ER now. If you dont come in an ambulance or claim to have chest pain you are considered to be using the er as a clinic or a drug seeker. You then are subjected to substandard care and more than likely not even examined..Ths atitude almost killed me! I am a cancer patient and have pain pills ordered. I always give this info if I go to the er. I also have had migraines in the past. In May this year I participated in a 2 day martial arts workshop and on the second day hit my head on someones knee. After arriving at the airport on my way home I got sick basicly concussion symptoms. We had been talking about that and I thought it was in my head. Starting as soon as I got home I was getting headaches off and on not really helped by lortabs..I put up with it a few days and then when it seemed to get worse I got a friend to drive me to the er ant 10 pm. I was checked in and had a bad headache at the time..the triage nurse sent me to the bright waiting room where I waited an hour before being given an er bed. The RN who took me to the room had seen my history and announced loudly o you are out of your prescription you just need one. After almost another half hour the physician came in and discussed my history. I told him about the head injury in martial arts and he asked if there was any padding. Then he stated he took his kids to karate lessons and it was no big deal. He never did any examination at all and ordered some kind of shot. I was discharged at 2am and had to find a ride home which I was actually able to do. The next day the headaches continued so I went to Urgent care. The md did a full exam and diagnosed me with sinus infection and gave me antibiotics, predinisone and imtrex po. I went home and after 3 days ran out of imtrex. I went back to urgent care and the same Dr said I need to get a brain scan immediately. I contacted my son and he drove me to a second hospital where I presented a note from the MD. they took my history and within a short period of time I was given a brain scan. As soon as I came out of the scan I was told that something was wrong and I would go to a more critical paart of the er. ON arrival there I was told about blood old and new in my skull and the diagnosis of subdural hematoma. I was told I need immediate surgery and within an hour I got it. I was in icu for 4 days in guarded condition but did improve and go home..I was told by several different md's that I was very lucky.
So if you treat a person you think is a drug seeker as a second class patient you are asking for big trouble...and it really sorry that er care has gone down so far..alot of it has to do with lazy personnel from the top to the bottom
I am the first to admit that I don't know all the details, or what CT scanning protocol is implemented in the ED that you presented to, but I am fairly appalled at what happened to you. If you had presented to my department with a traumatic / post head injury, worsening headache, which was not relieved with simple analgesia there is absolutely no way AT ALL (even if your neuro exam + vital signs were ok) that you wouldn't have been scanned in my department, regardless of your history with migraines. Add to that, if your scan was negative, they may well have done an LP to rule out a subarachnoid haemorrhage. Did you have other symptoms? (nausea / dizziness / visual issues). The fact that you are a cancer patient would have automatically placed you in a high acuity area for us (not the WR). I still can't believe that the second DR didn't send you for an urgent CT- but as I said, across the globe, protocols differ. For the record, the ambulance does not impress us, nor does chest pain most of the time. Unfortunately I hear horror stories like this all the time about other facilities, please believe me when I say not all Emergency departments are like this. The reason emergency nurses become so empassioned about dealing with narcotic seekers is that they take resources and time away from patients such as yourself who are genuinely sick. They are also the reason that any patient is suspected in the first place and potentially the reason you were treated so poorly. An experienced emergency clinician should not have made this assumption and appropriate investigations should have been carried out. This issue always polarises everybody, and there are no easy answers. I hope you recovered well.Last edit by NO50FRANNY on Jul 19, '12
3Jul 19, '12 by Dragonnurse1My first question is how did the mother and her child arrive? Did the mother drive? Obviously from your description the child was too young to have driven her mother so that brings me to my next question. How was the mother planning to get home? I do not know of any medical facility that allows a patient to be medicated with narcotics or opiates to leave without another licensed driver.
I worked in an ER and saw my fair share of "frequent flyers' ". I have also had migraines since I was 17 and lived with my father who also suffered with migraines. Let me add to that list herniated cervical disks, carpel tunnel, a bad gall bladder, and chronic radicular neuropathy of the right shoulder/arm so I am familiar with the pain issue from both sides - as patient and nurse. The true drug seeker is not very hard to spot. Having pain that cannot be "proven" either by lab, x-ray or CT is not the behavior to look for. The patient that comes in with pain and requests specific narcotic/opiate relievers because "nothing else works", it has to be given IV, "I am allergic to...(insert every general analgesic here ie: torodal, naproxen, reglan, motrin, acetaminophen), "I am photo-phobic" but they are staring up at the lights. True drug seekers can quote you every symptom for which IV meds are appropriate and they tell you how many cc's of ??whatever?? works. They want to be discharged as soon as the meds are given. When the Doc writes for a pain management follow up they get angry and defensive. They just need a new refill because they lost or spilled their current one (usually into the toilet or sink). Where is my driver - ugh he is in the car in the lot....no wait he is coming back to get me. They have food or a drink with them. And of course there is the medical record with multiple visits to the ER, either weekly or monthly.
You never look at someone as a drug seeker without having some other information that raises suspicion. You also will get to know them if you work in the same ER for a number of years. When the same faces and same names come in and you have had personal experience with said patient - you will learn them. Never assume anything, I got burned by one that managed to leave not only with 2cc mepergan IV and her INT still intact she drove herself away from the hospital but I also had one that was suffering her first attack of Sickle Cell and had not been previously diagnosed with the illness. Also remember pain is subjective, my pain may be a 5 to me but for you the same pain may be a 9.
Sorry for the long post but this subject is touchy for me. Having been labeled a drug seeker myself for the "chronic migraines" I suffered from, only to find out that I had herniated disks that required fusion and having neuropathy in one arm as a result, and then treating patients with pain issues as a nurse the last thing I want to see is anyone jumping to a conclusion without learning all the facts about each patient they treat.
2Jul 19, '12 by corky1272RNJust because a person is labeled a seeker doesn't mean that the nurse will deny pain medicine to the pt. If the physician orders Tylenol, then that is what you give, "just following orders" as another poster mentioned. Sometimes we advocate for the pt by trying to get more pain meds , but occasionally that is just d/t the pt "bugging" us not because we feel they need it. I have never denied meds, even when the pt stated pain a 10/10 while half-way snoring. Yes, pain is what the pt feels it is, but some are lying. And no I haven't "failed" them, the MDs who prescribe too much have allowed them to get addicted and use the system to feed that addiction. We all should take a chill pill!
1Jul 20, '12 by itsnoworneverI understand the "I do have pain" or "this is my history" as I have been there done that. I have trigeminal neuralgia myself...and the first time is showed up I was crying in the ED and REFUSED narcotics because I didn't want them to label me. I asked for some strong tylenol or something because regular tylenol wasn't helping...and the doctor even said she wanted to give me demoral and I said NO WAY! I dont want you to think I'm looking for drugs. Turns out I should have gotten it...an agonizing weekend until I could see my doctor and was diagnosed was horrible. So I get what you guys are saying.
To answer a few questions---mom drove herself (I also questioned how on earth she was going to get home if we gave her anything stronger than motrin) and her behaviors were suspicious. While I was crying in the ED with my headache, I wasn't moaning and yelling loudly every time someone walked by. I also understand that people handle pain differently, and I didn't mean for tempers to flair here or feelings to be hurt...I came here asking what you would do.
THese stories aregreat and things that I will keep in mind when I start working.
1Jul 20, '12 by ED_Chris_RNI treat all my patients the same no matter what. But I will say that our doc's tend to check and see what type and how many narcotic prescriptions people have gotten, if they appear to be "drug seeking". In a few cases I have seen patients who have gotten a ton of prescriptions for various drugs come in and want more, but ended up leaving with a prescription for Motrin.
0Jul 24, '12 by farmerjaneQuote from mrstmarieGood heavens. I don't even have a penis and I cringed reading this!!!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 penis causing trauma resulting in *blood in the urine* Amazing
OP, I have Trigeminal Neuraligia as well. I think what someone said about caring more about the medication than the pain relief is key here. If someone is truly in pain, they will do anything to stop it. I don't care what you give me---doesn't have to be a narcotic---as long as it helps with the pain.
That being said, I'm glad I don't work in the ED and face these decisions.
1Jul 27, '12 by TheCoppertopIts a tough one. There's no way around it. I struggle with keeping it impersonal because really, it can feel very personal sometimes. I worked at a small community hospital, very rural, and therefore the seekers didn't have shopping options. We'd get a certain few almost EVERY day, one especially already prescribed scads of vicodin, xanax, and soma. Her son was in the paper for selling drugs. Every day it was a new story of picking up her grandkid and feeling something pop in her back, or chest pain, or fell down steps, or migraine, I am not exaggerating when I say it was EVERY DAY. Sometimes she'd get a generous doc, sometimes not. In triage I even asked her "did you try taking your vicodin?" but she'd say she threw it up and needed dilaudid IM. What can you do? You just can't take it personally. Yes the true seekers lie to your face and you'll feel like you look like a fool believing them, offering a sympathetic smile and great customer service. It gets super frustrating when, like we often did, you have 3 nurses including yourself as triage/charge, 12 full beds, 8 waiting, a STEMI, a nasty bleed you're trying like hell to get flown and its about to start snowing, and oh by the way, SHE just checked in and you have to go triage her for picking up the grandkid wrong again. I try and just do my job, advocate for the pts when I can, and go home every day thanking God I'm not in her shoes. Its tempting to want to feel like you're giving in or letting them win a point by getting them high but you just have to do your job.
2Aug 13, '12 by houstonlvnI would medicate her with whatever Dr. ordered. Not my job to judge, or diagnose. I am not in her shoes, nor her body, and do not know the struggles she has to deal with in life. MAYBE is drug seeking as life has gotten to hard for her to handle at moment. She is on her own conscious to deal with if she's lying.
FOr yrs I was a "VERY" judgemental type person. Didn't help I was at the time married to alcoholic, and thoght I KNEW drug seekers when I saw them. THEN sure enough one day I thought that, and Dr's found nothing wrong, come to find out the ladie had a broken hip and her daughters (said she was a druggie) didn't know what they were talking abt. She was c/o stomach pain, and finally figured out that was because she'd taken so many otc's trying to stop hip pain. SO NEVER AGAIN. I will give whatever Dr orders and keep my opinion of myself.
1Aug 13, '12 by NurseOnAMotorcycleI would like to point out that Not One Nurse said that they would withhold MD ordered medication.
In every hospital, unit, and patient care are there are people who jump in and righteously demand satisfaction about a bad experience. So if one nurse and doctor in one emergency room are to blame for a bad experience, are all nurses and doctors in that emergency room or all emergency rooms rotten to the core?
I get so tired of hearing "I hate XX hospital. They didn't do YY correctly so they're all to blame for me having ZZ diagnosis."
2Aug 14, '12 by brainkandy87Quote from NurseOnAMotorcycleBecause if your MD has any brains at all, he won't give Dilaudid to an obvious drug seeker. So hopefully you two are on the same page. If an MD orders Dilaudid on a FF who's obviously seeking, yes, withhold it. However, I think it is in very poor judgment to not provide an intervention for someone complaining of pain simply because you think they are seeking. If the MD orders Dilaudid and you think they're seeking, ask him to order something non-narcotic. Simply withholding medication and not providing a different intervention is terrible nursing and below any standard of care.I would like to point out that Not One Nurse said that they would withhold MD ordered medication.
0Aug 14, '12 by JoryTo me, these situations were never difficult. Here is what you have, broken down:
1. You have a doctor that is responsible for prescribing...that is what they go to school for, and ultimately, it is their call. If you want to withhold because you think they are seeking, you had better be right, because if you are wrong, that is a valid reason for a facility to terminate you and can put your license MORE at risk than administering.
2. As a nurse, your job is to assess and report your suspicions, patient's history, etc.
3. Patient is requesting narcotics and brings her kid in.
Here is how you handle it:
1. Report your findings to the doctor...if he wants to prescribe her enough to put her into the twilight zone, I could care less. Drug seekers are drug seekers BY CHOICE and I have zero sympathy for them. Whether or not they receive the drug has no bearing on me whatsoever. The person who will have to answer for it is him if he's ever investigated for the opiates he writes...not you. As long as you are not giving injections that kills a patient or puts them in a coma, you are clear....but you also cannot be responsible (and neither can the doc) if they are taking other meds and won't tell you.
2. The little girl is another problem...Mom obviously drove there, Mom needs to drive back. As a nurse, you have the right to refuse to give the mother anything that will leave her impaired to drive and if she seems "out of it" while she is in the ER and insists on leaving, I would call social services (Police first)....because she instantly put that child at risk by getting into the car.
To me, it's a no brainer.
0Aug 22, '12 by CP2013Quote from CrunchRNWhat can you do but ... duct tape the kid onto a chair?
If only they let us bring duct tape in to the department for those days. Pretty sure it'd work better than a posey, 'cause you know duct tape fixes everything!
(Kidding of course, but funny to consider!)