As a RN with well over 20 years experience, the last 14 years in the ER.Prescription drug abuse is a serious problem that fully needs to be examined, documented, tracked.
Yes we have a large number of patients with drug related problems. But lets face it, whether you work in a busy ER or a crowded doctors office. Its is easy to overlook the obviousness of drug addiction. It is easier to wright a prescription.rather than spend an unlimited time with a person to encourage them to realize they have a problem, and their need to deal with it. In this the medical community bears far more responsibility for this tahn they want to admit.
Example, Pt Joe Blow has come to the ER 30 times this past year and he has always left with scripts for lortab and soma. And we know from neighboring ERs that he has been their also for the same. What do you do about this. Do the doctors in the ER as a group refuse to give him anymore meds. In which case he just hits other ERs.Then after a time off he eventually comes back. Does the ER doctor sit down at length and discuss with the patient his potential problem and how to deal with it. In a busy ER the doctor does not have time to do this, because then he is neglecting patients with possible significant pathologies presenting. Its rare when the doctors in my ER have that much spare time. Does the doctor just look at the patient and refuse to give them narcotics. This presents risks as well. You are open tp lawsuits for defamation,for refusing to treat a problem to provide pain relief measures. Or god forfid they complain to the department of health in your state, and they come out to do an investigation, because if they do, once in your doors they can look at whatever they want. And if they want they can recommend you for citations and or HICKFA violatins. I promise you , you dont want to deal with that. Do you notify neighboring ERs about this patient? I think not, that is a violation of pt confidentialty.And then you are open to further litigation.
And to further cofuse the issue, when JACHO comes for its visit. One of the main things they are focusing on the last couple of years is pain relief and the documentation of pain control. How are you going to tell they are just a druggie. It doesnt matter how often they come to the ER, each visit they may actually be in oain, and can you deny anybody relief from pain without taking risks. That all depends on how big your balls are. Because you can surely be placing them on the chopping block.
Even when you identify the patient as a drug abuser. Before you can decide not to give him pain relief, you have to work him up as an indivdual bases on each every visit, just to ensure the patients safety, and to protect your liability. This is a self perpetuating problem of immense proportions throughout the nation.
The only thing that keeps coming up to me is what my old nursing instructor, once lectured on. "judge not the patient in your care, but assess appropiately and intervene correctly and caringly in the best interest of your patient"
enough rambling from an now old nurse
tom livingston rn texas