[TazziRN]

Yesterday a young woman came in complaining of pain. The doc came out of her room and ordered Demerol. I asked if she had a ride, he said she had told him yes. I went in to verify.

Me: Someone drove you here?

Her: My husband.

Me: Is he in the WR?

Her: No, he had to leave. I was going to take a cab home.

Me: We don't have cabs here. (VERY small town)

Her: Oh. I can call my husband. When should I tell him to be here?

Me: Now. I am not going to medicate you until he's here.

(She gets out her cell and I leave the room)

Over half an hour later she beckons me into her room.

Her: My husband can't come for over an hour, so I'll just go home.

Me: For future reference, when you come to the ER for any kind of pain it's a good idea to bring a driver just in case, if you can.

Her: Oh, I drove myself but I was planning on leaving my car here and taking a cab home.

Me: *rewind mental tape recorder to part where she said her hubby drove her in*

An hour later I get a call from a pharmacy in the county seat, 50 miles up the freeway, wanting to know if her script for Vics was real because it was on black and white paper. This is in spite of the fact that we have a pharmacy in town open 7 days a week. And insurance wasn't the issue to where she was limited in where she can go, because she was self pay.

Methinks we have a new frequent flyer in town!

[lyraesullivan]

funny you should bring this up, recently we had a patient that drove 45 miles and passed up three closer hospitals to come and see us, red flag # 1 right there and despite being told several times no pain med until a ride is there (yes the Dr. did prescribe Dilaudid despite us obtaining a visit history from one of the other hospitals and ER records there raising the question of drug seeking -***?)spent a good hour trying to get every nurse that came by to medicate her and ultimately ended up leaving in a huff. She will be the one they call to get the press ganey score for this month.

in the last year we had to have someone arrested in the parking lot because she snuck out and ran into another car in the parking lot. That makes for a lot of entertainment for the people in the waiting room. We had another guy swear his wife was driving (luckily it was documented several times that he had been duly instructed blah blah blah) and then left and dozed off and rear ended another car 4 miles away from the hospital and the icing on the cake was a disabled Highway patrol officer that told me his ride was waiting in the car - oh really sir? You want me to believe that you have someone waiting in the parking lot in a car when it is 117 degrees outside? Nice try.

Oh yeah, almost forgot about the one that drug in some stranger from the lobby who was too scared to say otherwise and declared that her ride was there - all for one vicodin. Pathetic.

Our policy now is no ride? No meds. If you need to have a ride you either have it with you or you get sent back out to the lobby to find one and then we will put you in the next available room. If two patients come together neither one gets narcotics (except in certain cases but we've been burned on this one before)

The sad thing is how little the doctors back us up on this

[anne74]

God bless you ED nurses who deal with that on a daily basis! That would get old real fast.

The kicker is that these people get so mad with the "mean" nurse who won't give them their medicine. Never mind you have their best interest in mind.

[TazziRN]

Last week a nurse came in in withdrawals with her husband. She was going to go to a rehab center the next day but needed something to get through the night. She had called me and I told her to come in, that we could help her. She was so far gone in her addiction that she could go through 30 Vics in a day. The doc on duty wanted me to dispense some Valium to her, PLUS 30 Vics. I refused, partly because it would deplete our supply and partly because that was uncalled for. I agreed to dispense 6. After the pt was discharged (Yes, I trust that she went into treatment, because she hasn't been at work) I talked with the doc for a while about it. I told him that the nurse in me understood his decision but the addict in me does not. His answer was that it's not our job to treat her addiction. I said, "No, but it's not our job to feed it, either."

He got reeeeeeeally quiet. I'm hoping it sunk in. What's sad is that the nurse did not ask for the Vics, she just wanted some Valium or Ativan to take the edge off till she could get to the treatment center the next day.

[TinyNurse]

This always bothers me alot. In my hospital when the patient is discharged, they are discharged period. They are not allowed to wait in their room for their ride. They are to be out of the room NOW, so that the next patient can come back. So how am I supposed to know that their ride actually showed up, or that they actually call for one. Often times i've spoken to the "ride" on the phone, and asked for their full name, and then I chart that I spoke to the ride and chart their exact name.

Also.........so many different hospitals have different policies on WHEN to discharge someone after they've received IV narcotics. Some say 8 hours, others say 30 minutes with stable VS. What is the proper way?

Also....what are some of your feelings regarding a patient receiving narcotics and then taking the city bus home? or getting narcotics and being sent back out to the street because the patient is homeless?

[TazziRN]

In my hospital when the patient is discharged, they are discharged period. They are not allowed to wait in their room for their ride. They are to be out of the room NOW, so that the next patient can come back. So how am I supposed to know that their ride actually showed up, or that they actually call for one.

By not discharging until you see the ride. Since people who have received narcs are considered altered, you would be within your rights to request the ride bring the car around to the ER, where the pt would be walked out or wheeled out.

Also....what are some of your feelings regarding a patient receiving narcotics and then taking the city bus home? or getting narcotics and being sent back out to the street because the patient is homeless?

This is fine. The point is to make sure the narc'd pt is not behind the wheel of a car.