[ktwlpn]

Med surg nurses-do you really think you can make a difference in the true drug-seeker's behaviors in the few days you will be caring for them? YOU are not enabling or encouraging them-their docs have been doing that...Do yourselves a favor and give them meds as ordered and don't waste your positve energy in a negative manner.These people will suck the life out of you and monopolize you if YOU LET THEM...

[DutchgirlRN]

I totally agree with everyone. There is no such thing as a "drug seeker" in a hospice setting. Whether they want drugs for pain control, to sleep through their physical or emotional pain, or even if the drugs are meant to help hasten the death. It's their decision. No patient in hospice shoud ever be made to feel guilty about taking pain meds or whatever !

[obeyacts2]

Originally Posted by Brickman

If someone is in the hospice system than I can't imagine why anyone would care how much pain meds they want. If having 6 months or less to live isn't a good reason to be heavily medicated all the time even to the point of being a little high, than what is?

Amen!!!!!! I dont care if my terminal pts drink MS out of a water glass !!!! Lots of the CA pts around here are on heavy duty Fentanyl patches plus MS q4h plus Atiivan/Haldol if needed.

As an aside, I was wondering if a pt with a prior hx of drug addiction, would automatically need a much higher dose of MS to combat pain. Long ago, before I knew to ask. I had a pt (young) that years prior had drug addiction hx. He had cleaned up/gone thru rehab and years later developed terminal CA. This guy got MEGA doses of MS, like towards the end, 10 cc every few hrs. Later, they switched to nebutalized MS rectally, and when that didnt work, they put him in the hospital where he died. Is the huge doses due to the prior drug hx/ or increased tolerance?

laura

[talaxandra]

I've got to agree, at least in part, with ktw - drug-using inpatients aren't usually in a place where they're going to change their behaviour, unless they're in a detox centre. Working in ER is different, and I have no problem with not providing patients there with meds, but unless we're prepared to follow up withholding/reducing meds with counselling and other support all we're doing is creating an unpleasant situation for everyone. I know I'm not receptive to anything when I've got pain - compound that with withdrawal and some sanctimonious, judgemental nurse getting in my face and the last thing on my mind is going to be cooperation.

[Mister Chris]

Originally Posted by TDub

Doesn't matter if they're seeking meds or not. They're dying. Dope them to the gills if they want.............................................. .Keep an open mind. Know yourself...

Yes have to agree with all of the positive input - after all "they are dying" arn't they?
Just hope that some hospice/pal. care nurses still feel that way if and when I ever end up in a hospice/pal. care unit.
Mister Chris

[NoCrumping]

Originally Posted by DutchgirlRN

I totally agree with everyone. There is no such thing as a "drug seeker" in a hospice setting. Whether they want drugs for pain control, to sleep through their physical or emotional pain, or even if the drugs are meant to help hasten the death. It's their decision. No patient in hospice shoud ever be made to feel guilty about taking pain meds or whatever !

exactly!!!! they NEED drugs, they are dying, and most are in severe pain!!! If a person is in hospice, does it really matter if they are drug addicted or not? its not like we can stop an addiction from happening to a person who is DYING anyway.they are DYING!!!!! who cares what they are seeking......sorry, but even the term "drug seeker" in a hospice setting makes me so mad i sputter my words........

[NoCrumping]

Originally Posted by hospicenurse

I think it's even scarier that you are attacking her for expressing her thoughts. She needs our support and education, not decapitation.

she's right........her "thoughts" are scary to say the least. "drug seeker" in hospice......rediculous.shes going to work in a hospice setting and asks this question???? come on, people....very scary.how would that go anyway, ....."well we have this end stage bladder ca with mets, does he really need all this medication, or is he feeding an addiction that we must not contribute to?" You bet he has an "addiction" and is SEEKING drugs.thats why he is a HOSPICE pt. They get all they please to get, because they are DYING AND IN PAIN. I feel like this: IF THIS NEEDS TO BE EXPLAINED TO YOU, THAT ADDICTION IS A NON ISSUE IN HOSPPICE, THEN YOU SHOULDN'T BE A NURSE, PERIOD.

[NoCrumping]

[quote=gianine]

Originally Posted by JacelRN

First let me clarify.

Have any that have replied ever worked on the type of floor I currently work? Please don't tell me that you haven't seen these types of patients. There are abusive personalities and it dosen't stop in the hospital. I do not feel comfortable supporting drug habits of patients. Even when my patients ask to go out to smoke, I educate them on the importance of not smoking. I assess their needs to find alternatives.

I turned to this board for advice and from those of you who tried not to judge ME by my response, thank you. I intend to reasearch hospice, palliative care, etc. For those who are less patient to judge a vulnerable poster, please read this and know I was attempting to clarify and educate myself on an important move both in my career and in my beliefs. I was not presenting a case for debate.


I worked in Hospice for several years, then left because our Hospice was taken over by a large hospital corporation. During the 2 years that I was gone from Hospice (I am now working in Hospice again), I worked on an oncology/neurology floor. Most of our neurology patients were there for laminectomies or some other back/neck surgery. We had a contract with the federal prison and the county jail to do all of their surgeries. I can tell you that even though I tried not to be judgemental, there were times when some of the (prisoner and non prisoner patients) would try my patience. I would always give the patients pain medications and never questioned their pain and in fact, I would call the doctor and ask for an increase if the patient was "timing" their meds. I wasn't very popular with the neurosurgeons and many times they would not give me orders to increase the meds. I knew that some of the patients were seeking meds for other reasons than physical pain and because of the unbelievable busy schedule on a med-surg floor, I would find myself feeling very irritated by their constant requests. I was also taking care of cancer patients on the same floor and found myself being more compassionate towards them and angry at the patients who could walk and talk and would be going home to heal after a day or two. I don't think that I showed my anger towards the patients...at least I hope that I didn't. Many of the people we were taking care of on that floor had been abusing drugs prior to coming and I had learned during my hospice years that these people had pain just like anyone else, but require more pain meds to control their pain. Somehow, the MD's that were attending did not understand this principle.
When I worked in Hospice previously, I had a few addicts that came on to service and fortunately their doctors were good to them and would give them whatever they needed to be comfortable. I think that you will find it easier to control a patient's pain in Hospice because most of the time the docs are willing to medicate a patient with a long acting med and increase as necessary. The problems with pain control in the hospital setting are vast. Most of the patients are in there for a short period of time and the docs are just interested in getting them out ASAP and they don't want to think about long acting pain meds.
In the hospice setting, we know the patient is dying and we give them whatever they truly need to help their pain, whether it be physical, emotional, or spiritual. A patient with prior drug abuse history has just as much pain as someone that doesn't. Just remember that they will probably need a great deal more meds than most everyone else.
I hope this helps and does not sound judgmental.

YES , I , AND OF COURSE OTHERS KNOW A "DRUG SEEKER" TYPE......in an acute care setting.....but, let me just say this: HOSPICE PATIENT= LICENSE TO BE A DRUG SEEKER. i AM SORRY TO BE HARSH, BUT I THINK YOU SHOULD KNOW THIS, AND NOT EVEN HAVE THIS ENTER YOUR MIND WITH A HOSPICE PATIENT.

[mjamesRN]

Drug-seekers on a Med-Surg floor can be a difficult endeavor -- one you really shouldn't have to manage alone. Most hospitals have a Pain Management team that can help.
Hospice is an entirely different animal. I had a guy with endstage pancreatic cancer who had been on pain killers and was an alcoholic all his life and, by the time I received him, had a port and a Dilaudid pump that was delivering 180 mg/ hour PLUS q15 minute 30 mg boluses for breathrough. (These high doses apparently aren't uncommon with oncology patients), however, He was beginning to have myoclonic twitching -- was verging on fullblown seizures and possibly a stroke -- from the high doses of Dilaudid. If we even pulled back a little, his pain would skyrocket. In otherwords, there was really nothing more we could give him. He was already on Oxycontin as well and morphine or methadone wouldn't even touch his pain. He died in pain. One good thing was he kept a sense of humor right until the end and his wife was wonderfully supoortive and caring.

[aimeee]

Originally Posted by NoCrumping

YES , I , AND OF COURSE OTHERS KNOW A "DRUG SEEKER" TYPE......in an acute care setting.....but, let me just say this: HOSPICE PATIENT= LICENSE TO BE A DRUG SEEKER. i AM SORRY TO BE HARSH, BUT I THINK YOU SHOULD KNOW THIS, AND NOT EVEN HAVE THIS ENTER YOUR MIND WITH A HOSPICE PATIENT.

Read the entire sequence of this thread and you will see the thread originator came to a new understanding through the dialogue here. The negative comments she received from some resulted in a defensive position. Gentle education works wonders in bringing others around to your point of view while sharp words just tend to make others turn away or entrench themselves more deeply.