When patients lie about rides.....

[TazziRN]

I had a pt this morning, rib pain after a play wrestling match a few days ago. He drove himself to the ER and rated his pain at 11/10. I got an order for Vicodin #2, and before I let him have it I had him call for a ride. I spoke to the friend, whose wife is a resident in our LTC unit, he said he would be with her and would await our phone call. I medicated. When he was ready for discharge I was off the unit and a coworker discharged him. He told her that he would just walk down to the LTC and get his friend to take him home. When I came back and found that out I cringed. (Coworker is new to ER, was a PACU nurse.) When I explained how it should have been done, she said "But he said he was going to go over to LTC for his ride home."

About a hour later a man knocks on the ER door. It's the friend wondering how much longer it's going to be because he's ready to go home. My cringe was accompanied by a silent moan. When I explained what had happened he shook his head and said "His truck's not in the parking lot and he never came to get me."

I told the friend to "beat up the pt's other side when you find him"!

[EmerNurse, BSN, RN]

In our ER, folks who come by ambulance for non-emergent problems (sore throat x3 weeks, maybe?) get sent to triage and the WR where they can wait their turn with the other 400 people in there.

I have had folks d/c'd at 3am wait in our WR for morning when the bus services start again or they can get their ride. I'll happily provide them a blanket if it's cold or even a juice and some crackers if it's been a while (the obnoxious ones starve though lol).

Not had too many who lie about rides, thus far anyway, but I always document my instructions really well, just to CYA. And the cops transporting folks? Heh only if they're in handcuffs lol.

Love my job, oh yes I doooooo :monkeydance:

[TazziRN, RN]

One pt learned the hard way.....I'd known her for years, she used to come to my old place of work with shoulder dislocations, then moved to another town and started coming to where I am now. One day, after being medicated and reduced, she drove home herself....her ride showed up and dropped her off at her car in the front lot. I forget how we found out, but the next time she came in I refused to medicate her until I saw the driver. Driver showed up, I explained that I was about to medicate the pt and that they would be observed leaving, that if the pt drove herself I would call the cops. Pt acted surprised until I told her she'd been caught, and she was embarrassed.

[33-weeker]

oh, thanks for this bit of information, nremt. i didn't know that either. i know that it works very well for pain. when i was d/c from an ed a while back, i even asked the doc for a prescription for it. i was really baffled when he was reticient to write for it, and when he did, he only wrote for a very limited number (like 8 or something). i have found out since that one can only take it for a week at a time without incurring liver damage (i think).

on our postpartum unit, they limit the doses to 6. this is due to the effect of increased bleeding (hinders clotting time) -- not a good thing when you've just had a baby.

[aberrn]

I work night shift in a small rural hospital with a free ambulance service for those without private insurance. We have patients who come by ambulance for minor complaints, using the ambulance as a one-way taxi service to the ER, also bypassing the waiting room! These patients have no vehicle, no way home, and usually can't get ahold of anyone. The taxi only runs until 3am and patients claim (and I don't doubt) that they have no money for a taxi. Then there is, of course, the patients who were "dropped off and will call their ride when it's time to leave," and then the ride can't be reached. To withhold narcotics until a patient has a ride in the department would tie up the room, causing further delays to patients in the waiting room who need to be seen.

This is such a common problem that we routinely call dispatch to have a cop drive the medicated patients home! This seems crazy to me, and is a pet peeve of mine (and the cops). The cops should be patrolling the roads and available to respond to calls, not playing taxi. Maybe I'm heartless, but I feel patients who either lie about having a ride, or who's ride has become unavailable/unreachable, or who came by ambulance for non-emergent complaints should just have to wait in the lobby until morning when they can get ahold of somebody. Of course the ones who drove to the ER probably would sneak out, and others would try to walk home in the dark, in which case our documentation would have to be adequate.

I haven't voiced this opinion at my work because it does sound heartless and I'm afraid it would make me look bad to the higher-ups who are all about patient satisfaction and caring about the patient. I'm curious to know what others think:

:confused:Am I heartless and mean to think this way? Or is the practice of using the cops to transport these people home as crazy as I think it is?

Also, do your ED's use the police to transport patients home? Any suggestions?

Likewise,our local cops would laugh like crazy...

If I'm suspicious of the patient I will wait for their ride to show up before giving meds.

Then document! document! document...

Sometimes people will sit in the wr until the first bus arrives.Hate it!!.

[twotrees2]

um... I actually did this once. :chair:

Before everyone gets mad at me, let me explain. I was working at the hospital as a CNA while in nursing school, and injured my back near the end of my shift when a large patient passed out while I was walking him to the bathroom. I couldn't straighten up, so as per policy I went down to the ER. I would not accept anything stronger than a shot of Toradol, since I know from experience that Toradol works much better for my pain than morphine or demerol, and since it is an NSAID it doesn't make me loopy. After the shot had taken effect and I was discharged, the nurse told me that I was not allowed to drive myself home. I had NOONE else to get me, and all I had been given was one shot of Toradol. So I told her that my husband was already in the waiting room, and I left and drove home. If I had taken ANY narcotic, I never would have done that. However, I was single and had lived in the area for about five months so I literally had noone to call. I had been given IM Toradol on numerous other occasions so I knew that it would have no effect on me as far as impairment.

Don't hate me!!!

i think we all do things we shouldnt sometime in our lives especially when we were younger and "knew it all" lol - i did once to drive and it was on a hypo of demerol i believe it wsa - wayyyy back when i had driven myself in and been accused of drugabuse ( which turned into nearly dying due to ruptured gangrenous cyst - story ive told in another thread ) .......... i had made calls and did have a ride coming but it was gonna take over an hour - being a smoker and going nuts they did not believe me about my pain i didnt want to look at them so i signed out telling them i had a ride coming - i was so distraught i decided id wait outside - well while waiting - being higher than a kite of course - my anger at the situation and the way i was treated made me angry so -i decided to drive - not good and i wouldnt do it again.........i thank god nothing bad happened even though i only had a few blocks to go. my ride was NOT happy with me of course and being my parent he sure reamed me but good - after i was finally coherent from my emeregncy removal of the cyst.................................... hahaha id never do it again just for the fact my dad reamed me but good if i wasnt now a nurse and figured out what could have happened. lol. dads scary hahha. ( kidding hes the best but boy when he talks i listen even now hehehe)

[twotrees2]

Our local police force would get a big laugh if I called them to give someone a ride home.

the only time the cops gave oneof our residents a ride home was when he got lost getting out of the buildoing and thankfully ending up at the police station ( not some store or bridge) ( a dementia resident) - police got a giggle but glad iwasnt on shift at the time- how horrifying to think what could have happened.................... now we have alocked unit thank god. not the best lock but better than none.

[Justhere, BSN, RN]

um... I actually did this once. :chair:

Before everyone gets mad at me, let me explain. I was working at the hospital as a CNA while in nursing school, and injured my back near the end of my shift when a large patient passed out while I was walking him to the bathroom. I couldn't straighten up, so as per policy I went down to the ER. I would not accept anything stronger than a shot of Toradol, since I know from experience that Toradol works much better for my pain than morphine or demerol, and since it is an NSAID it doesn't make me loopy. After the shot had taken effect and I was discharged, the nurse told me that I was not allowed to drive myself home. I had NOONE else to get me, and all I had been given was one shot of Toradol. So I told her that my husband was already in the waiting room, and I left and drove home. If I had taken ANY narcotic, I never would have done that. However, I was single and had lived in the area for about five months so I literally had noone to call. I had been given IM Toradol on numerous other occasions so I knew that it would have no effect on me as far as impairment.

Don't hate me!!!

Was in the ER last month and they gave me Toradol and I specifically asked them do I need a ride home because I drove myself and they said

"No" it is ok to drive after taking toradol.

[TazziRN, RN]

I have had some pts tell me that Toradol has a sedating effect on them, but they are few and far between. Because it isn't a common effect, it's considered non-sedating. Those that tell me it hits them that way also tell me that advil and tylenol can do the same thing to them.

[BabyRN2Be]

I have had some pts tell me that Toradol has a sedating effect on them, but they are few and far between. Because it isn't a common effect, it's considered non-sedating. Those that tell me it hits them that way also tell me that advil and tylenol can do the same thing to them.

Maybe it just seems sedating because once the pain is gone, the patient can finally rest a little easier. Especially if they've been in pain for days with little to no sleep.