Narcotic Administration in ER

Specialties Emergency

Published

I am curious what hospitals around the country are doing regarding narcotic administration to patients with no ride home present, no ride home period, or the homeless population. We have to treat a patient's pain, but NSAID's are either not enough, or are flatly refused. I am curious if there are written protocols out there, or if ER nurses are using a unwritten protocol. I feel like I am being squeezed between angry patients, frustrated doctors, and an unhelpful management. Thanks.

Specializes in Emergency.

Just because it is illegal to drive under the influence doesn't mean it is illegal to provide proper pain relief to someone who doesn't currently have another way home. In fact, there is a law against not providing proper care regardless of how the patient got there or how they plan on leaving.

Now, I do take into account what the patient wants, and if they have a ride home. Some patients will ask to not have narcs given because they don't have another way home, and I will try to accommodate their needs. I've sent patients home on the bus, or had them wait either in the room or in the waiting room. We've had staff take patients home when they got off because the patient didn't feel able to drive themselves at that time.

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[h=1]Actually this is a Current Study BY ENA [/h]I've copied and pasted from ENA website. This topic just happen to come up in our ER today and I was doing a little research so I thought I would share it . It's interesting that there is no standard really established YET.

Page Content

ENA Initiatives

Discharge Processes for Patients Receiving Schedule II and III Medications for Pain Management in the Emergency Department

Schedule II and III narcotics are frequently prescribed for use in treating acute pain while a patient is in the emergency department. Although guidelines exist on the prescription of these medications after discharge (2012), criteria for discharge from the emergency department after Schedule II and III narcotics are given are difficult to find. Pediatric literature makes suggestions for both the emergency department and the ambulatory surgery setting; however Pediatric patients, however, are never discharge. Furthermore, there is a paucity of literature on the current discharge practices for adult (over the age of 18) patients who have received Schedule II and III narcotics in the emergency department. Therefore, patients may spend more or less time than they need in the emergency department, with the attendant patient safety and throughput issues. This variability in discharge practices directly impacts the practice of emergency nursing, as emergency nurses are the frontline caregivers for patients who have received Schedule II or III narcotics during in the emergency department. The purpose of this study is to understand common practices in the discharge of patients receiving Schedule II and III narcotics in the emergency department in terms of dosage, time, availability of care resources at home, and other discharge criteria

Recruitment status: Focus group recruitment is now closed. Please check back for an opportunity to participate in the second phase of this study.

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We are having an issue with this in our ED and currently have no policy to support practice. Wondering if someone might sneak me a copy of their policy...Pretty please..:angrybird5:

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Hey Zippy-

Your posts are so outlandish, I assumed you were a one time wonder, made up username to stir the pot. It happens around here. But I just checked, and apparently you are real. I'll be polite and just say you are way off base.

OP-

Where I work has similar problems- a variety of practices with no clear policy to guide. I never document that the pt has a ride. I have no idea what they do once they leave, and take no responsibility for it.

"Pt's wife state she is driving"

If the pt is driving, I hang it on the doc, and will document something to support their decision.

"OK to discharge pt, per EDMD. PT speaking clearly, walking with no apparent difficulty."

I am very skeptical about some of the approaches stated in this thread.

Drivers- How would you know who is driving? If they look sketchy, or have that "liar look" in their eyes, do you follow them? When the man in the couple is the type of guy who regularly drives impaired even when when his partner is sober, do you really think she is driving home? (Yeah- I know, stereotype. Could go the other way.)

In fact, sometimes when I dispense meds, I am pretty sure they are being shared on the way home, washed down with a beer. I mean it's the least you can do for a buddy who takes you to the hospital.

As far as the "no ride = no narcs" I am not buying it. Really? A dislocation with no narcs? A displaced FX going home after closed reduction? A painfull presentation and a negative workup?

All of the above only get narcs if they have a ride? Good luck ever justifying that legally and ethically. For one thing, having a ride is largely a socio-economic issue, and discriminating on that basis is a bad idea. And what about places like NYC that rely on public transportation?

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I would like to know if you can refuse to have morphine injection when you visit the ER and you know your problem does not require it. I don't feel a strong medication like that is required especially if you are not leaving with something for pain you may as well take aspirin Or Tylenol while in the ER if that is what is going to be prescribed for pain when you leave. me personally I don't want anything like that in my system.unless I have cancer I have been in a car accident and lost a limb or have had surgery.if there are any nurses I would like to know can you refuse morphine injection if it is prescribed by an ER doctor and you don't feel you need it

my daughter visited the ER with an infection in her Netherlands and they gave her morphine and they gave her a antibiotic then they sent her homeand in the discharge papers she was not prescribe anything for pain in a situation like that was the morphine needed in the first place isn't there something that's less strong that can be given for pain prior to x-rays and blood drawn results being seen. I remember once I went to the ER for fibroids and was given morphine and was sent home with nothing for pain I felt the morphine injection was unnecessarily prescribed to me and it also scared me.

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What you said is pretty sad and it's upsetting because it makes it bad for others who are actually in pain so you make a generalization overall for everybody there by allowing true Patients to suffer how is it that you can tell a patient is in pain would be by the findings that you see after Drawing blood and doing x-rays. If you find that patient is truly in pain don't assume that they're there to acquire pills to wash down with a beer.also there wouldn't be a problem if a lot of ER doctors weren't prescribing morphine for no parent reason.I know this something that can be substituted that is less addictive for the patient.

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I would like to know if you can refuse to have morphine injection when you visit the ER and you know your problem does not require it...

You can refuse whatever you want. Nobody is forcing it on you.

And why was this 5 year old thread bumped?

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What? If you don't want it bumped remove it , and you are rude , I was lead to your hopeless site by a question I asked in Google .. No need to reply

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What? If you don't want it bumped remove it , and you are rude , I was lead to your hopeless site by a question I asked in Google .. No need to reply

I don't think the bump comment was directed at you.

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What? If you don't want it bumped remove it , and you are rude , I was lead to your hopeless site by a question I asked in Google .. No need to reply

First, it was not directed at you, so just relax.

Second, it was not rude, it was a question as to why Ritaville3RN bumped a 5 year old thread instead of starting a new one to ask for information. Heck, I even answered your question. If I was rude, it would be painfully obvious. Bumping a 5 year old thread with no relevant information is ruder than anything I posted.

Third, it is not my hopeless site. This site belongs to Brian Short.

It is obvious by your post your not in the medical field. You can not diagnose pain by blood tests or x-rays. Pain is a subjective thing that only the person feeling it can know.

You complain that you and your daughter (for an "infection in her Netherlands"???) received morphine for pain, yet you both came to the ER because of pain. Did you try treating the pain yourself first? You should have, and therefore the next step is a stronger pain medicine than OTC meds, and in the ER, that is primarily morphine. Most patients are glad to receive relief of their discomfort with the use of morphine. You apparently did not. You now know in the future you can refuse morphine (or any treatment) when in the ER.

I need to stop now before I get rude (or did I already?).

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First, it was not directed at you, so just relax.

Second, it was not rude, it was a question as to why Ritaville3RN bumped a 5 year old thread instead of starting a new one to ask for information. Heck, I even answered your question. If I was rude, it would be painfully obvious. Bumping a 5 year old thread with no relevant information is ruder than anything I posted.

Third, it is not my hopeless site. This site belongs to Brian Short.

It is obvious by your post your not in the medical field. You can not diagnose pain by blood tests or x-rays. Pain is a subjective thing that only the person feeling it can know.

You complain that you and your daughter (for an "infection in her Netherlands"???) received morphine for pain, yet you both came to the ER because of pain. Did you try treating the pain yourself first? You should have, and therefore the next step is a stronger pain medicine than OTC meds, and in the ER, that is primarily morphine. Most patients are glad to receive relief of their discomfort with the use of morphine. You apparently did not. You now know in the future you can refuse morphine (or any treatment) when in the ER.

I need to stop now before I get rude (or did I already?).

Forum comments like this always make me laugh and they are part of EVERY kind of forum...if someone finds and old thread and responds for future people or have a question, they get harassed for bumping an old thread. If someone makes a new thread because they either didn't look or couldn't find any old threads dealing with their question they get jumped on for not looking at old threads.

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True. I have no issue with old threads being bumped if it is relevant or adds to the discussion. But they are usually bumped by first time posters (that have used the search, so I give them that) that are bumping a dead thread. The original poster is usually not even around anymore, then other new posters come in adding more irrelevant information and get butt-hurt over things not even directed at them (was that rude? :up:).

In the case of this thread, Ritaville3RN would be better served by starting a new thread (with a disclaimer of "I searched but could not find the answer I needed") to ask for what they needed.

Instead we end up with a really old thread revived that does nothing for the original topic (my posts included :sarcastic: ).

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