[Chuckie]

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[JennieBSN]

We actually had an OB patient that did this kind of crud. Severe cardiomyopathy at age 25 due to excessive use of crack. 10% cardiac output on a good day. Could've dropped dead walking to the bathroom. Used to come in to the hosp. in SVT's, freaking out, fresh off a crack binge. Would stay a few hours, come off the crack, and sign out AMA. We finally got her involuntarily committed at 28 weeks.

ANYWAY, she had this nasty little habit of going down for 'smoke breaks' and coming back high. Her MOTHER was her dealer, so it was quite easy for her to pull off. Once the docs and nurses figured out what was going on, it was mandated she had to have nursing 'supervision' to go for a smoke break. Couldn't be a CNA either, due to her severe cardiac probs....the 'supervisor' HAD to be a nurse. Needless to say, she stayed sober until we delivered her.

If involuntary committal is out of the question, try getting the docs to sign an order on her chart that a nurse has to go with her on smoke breaks like we did. It was a pain in the a**, but it worked well, and was better than having to deal with a patient high on crack....plus, when you have to have a 'babysitter' to go with you for every smoke break, you want to smoke less and less and less... .

[MollyJ]

I was interested to see this post and it's reply. This really shows the problem of working with addicted populations who may or may not be ready to get help for their problem.

Honestly folks, this occurence is great material for confronting. Dollars to doughnuts, the person is in the hospital needing a saline lock because of a chemical related problem and the issue of treatment for addictions needs to be addressed. as we saw from the other post, you have more leverage if the person is a minor, is pregnant or has a caring and concerned spouse/partner who is willing to feel and act on their alarm about this.

So tell me, what do floor nurses need? Is it access to a hospital based case manager OR treatment center liaison who knows how to do confrontation (after working with the unit based nurses, the docs, the family and friend of the client who may be concerned). In an addicted person's life, all of us are less powerful by ourself saying, "I'm concerned," but when many, many people come together and say that same message and the "person with the most power" in that person's life is willing to act on creating a treatment plan, then the person has a chance for change. So I am not saying that nurses should do confrontation by themselves. I am saying the person needs confrontation (and access to meaningful treatment, which actually is in severe shortage).

Don't forget that the mere act that you _puncture_ their vein can be a cue to use for some users. (you don't cause their urge to use, but you inadvertently create an environmental cue, as does the stress of being in such a controlled environment.) People dealing with addictions are aggravating and time consuming for the bedside nurse but I believe that using a saline lock is a very overt sign of out-of-control use that needs attention. True most docs are a little overwhelmed by the what to do and some of these people have NO one in their lives who cares enough about them to hold them accountable. If the patient is a frequent flyer to your unit, you all might come the closest to being that person.

I don't have ALL of the answers to the problem here but I think if this problem occurs enough, we as nurses have to do a better job of making care plans that get at the underlying causes.