"I'm NOT going to support his habit...." LONG - page 2
I've had two patients who are well-known drug addicts (UA's done and they tested positive for every drug on the panel) who had large abscesses drained from their arms. Abscesses were due to IV drug... Read More
Nov 15, '06Quote from JolieI agree. By law, drug addicts are considered disabled individuals and to deny them pain relief for bona fide medical reasons (not the frequent flyers that come into the ER for migraine meds when a migraine doesn't exist), I think is extremely unethical and cruel.You have a legal obligation to question and refuse to carry out inappropriate medical orders. To do a painful dressing change without sufficient pain medication is indeed an inappropriate order. Let your charge nurse know that you will NOT participate in carrying out this order. She can address it to the physician and/or do it herself.
If the doctor has a personal ethical issue with properly treating drug addicts, then he should excuse himself from the case so another doctor can properly care for them.
Nov 15, '06Quote from BSNtobe2009The pt also has a right to request another physician, if he feels he is being neglected/mistreated because of his addiction.If the doctor has a personal ethical issue with properly treating drug addicts, then he should excuse himself from the case so another doctor can properly care for them.
Nov 15, '06It is not the hospital staffs job to rid this man of his addiction, or make him face the consequences of his addiction. This man deserves pain medication in amounts that will bring his pain down to a tolerable level without causing serious adverse effects just like everyone else. Pain is a vital sign. If it isn't being treated then this is neglect pure and simple. I'm appalled at the doctor.
Nov 15, '06That is totally unethical! I wouldn't work for a person that had a mindset like he does. I would refuse to do the dressing change without proper pain control. It is cruel.
Nov 15, '06Quote from TriageRN_34Thanks for the reminder, Triage.Pain is now considered a vital sign ...
Nov 15, '06Bless you all! You guys are giving wonderful advice. You know, Tazzi, I've asked myself that question.....if I really want to work somewhere that condones this behavior. But I live in a small town, and I really feel connected to the people I treat since I am able to follow up on them and see them everywhere, not just in the hospital......95% of the time the good outweighs the bad. I don't think it's a job I will do for 20 years, however.
UKRNinUSA, do you have any references that you could send my way regarding use of peroxide and wet-to-dry dressing changes? If I had some research to back me up it might make a difference. Thanks for your help!
Nov 15, '06Quote from TazziRNThe problem is, it didn't sound like he knew pain relief was purposely being withheld from him because he was a drug addict and that the doctor and nurse manager "were not going to support his habit."The pt also has a right to request another physician, if he feels he is being neglected/mistreated because of his addiction.
Nov 15, '06I did tell him that he needed to demand to know why he wasn't getting adequate pain meds, and not to be intimidated by the physician since it's the physician's job to take care of him and give him the best medical care possible. Unfortunately, we're a one horse town. No other surgeons are avialable within a 50 mile radius.
Nov 15, '06Re emboli related to peroxide wound irrigations:
Jones PM. Segal SH. Gelb AW. Venous oxygen embolism produced by injection of hydrogen peroxide into an enterocutaneous fistula. Anesthesia & Analgesia. 99(6):1861-3, table of contents, 2004 Dec.
Sun WZ. Lin CS. Lee AA. Chan WH. The absence of arterial oxygen desaturation during massive oxygen embolism after hydrogen peroxide irrigation. Anesthesia & Analgesia. 99(3):687-8, table of contents, 2004 Sep
Henley N. Carlson DA. Kaehr DM. Clements B. Air embolism associated with irrigation of external fixator pin sites with hydrogen peroxide. A report of two cases. Journal of Bone & Joint Surgery - American Volume. 86-A(4):821-2, 2004 Apr.
Schwab C. Dilworth K. Gas embolism produced by hydrogen peroxide abscess irrigation in an infant. Anaesthesia & Intensive Care. 27(4):418-20, 1999 Aug.
Haller G. Faltin-Traub E. Faltin D. Kern C. Oxygen embolism after hydrogen peroxide irrigation of a vulvar abscess. British Journal of Anaesthesia. 88(4):597-9, 2002 Apr.
Konrad C. Schupfer G. Wietlisbach M. Gerber H. Pulmonary embolism and hydrogen peroxide. Canadian Journal of Anaesthesia. 44(3):338-9, 1997 Mar.
Nov 15, '06Re advanced wound products versus "wet to dry" dressing effectiveness:
Kim YC. Shin JC. Park CI. Oh SH. Choi SM. Kim YS. Efficacy of hydrocolloid occlusive dressing technique in decubitus ulcer treatment: a comparative study. Yonsei Medical Journal. 37(3):181-5, 1996 Jun
Lindholm C. Leg ulcer treatment in hospital and primary care in Sweden: cost-effective care and quality of life. Advances in Wound Care. 8(5):48, 50, 52, 1995 Sep-Oct.
Mulder GD. Cost-effective managed care: gel versus wet-to-dry for debridement. Ostomy Wound Management. 41(2):68-70, 72, 74 passim, 1995 Mar.
Blackman JD. Senseng D. Quinn L. Mazzone T. Clinical evaluation of a semipermeable polymeric membrane dressing for the treatment of chronic diabetic foot ulcers. Diabetes Care. 17(4):322-5, 1994 Apr.
Gates JL. Holloway GA. A comparison of wound environments. Ostomy Wound Management. 38(8):34-7, 1992 Oct.
Overall, it seems wet to dry dressing usually do an equivalent job, but it takes longer, is less cost-effective, and causes more pain for patients.
Nov 15, '06My ...
Unless the patient has specifically requested no opioids, and is trying to detox, he/she should be getting pain meds, regardless of addiction. You are there to treat the abcess/injury, not the addiction. I don't withold food from the obese, even though I might think that they eat too much. I don't withold formula from a new mother because I think she should breastfeed...
Nov 15, '06UKRNinUSA,
I am so utterly appalled at your post I can barely type. Who are you to judge? Who are you to hand out karmic revenge? You have an obligation as a professional to be compassionate, caring, and non-freaking-judgemental!
Since you are now in the good 'ol US of A there is a greater than 60% chance that you are overweight. If you are diagnosed with CAD secondary to excessive lipidemia should I withhold vital meds from you because you are reaping the seeds sown from years of eating poorly and little exercise? Because you deserve to suffer!!!!!!!!!!
If you were being an idiot and jumping your dirt bike off ramps in the parking lot and fractured your femur should I deny you care because you're stupid? If we based the level of care we gave our patients on thier life choices we would be denying care to just about everyone.......and this likely includes you. Are you PERFECT? Have you never make a single mistake?
For some addicts thier mistake was trying something ONE time at a party w/ some friends. Many addicts were once lawyers, nurses, CEO's, mothers, sisters, and fathers. People make mistakes, but it is not for us to condemn them to hell on earth (inadequate pain management) because of our own bigotry and prejudice. And that is exactly what you are displaying .......bigotry and prejudice.
Please educate yourself on addiction and pain management for the sake of your patients. MUCH has been learned about those subjects in recent years, I'm sure you could benfit from some CE on the subject.
Whoever taught you nursing theory, and basic pain med administration should be fired. They obviously didn't get the point across.
Nov 15, '06wildmountainchild, did you read the second post that UKRNinUSA posted? It was further explained in that post. Obviously you have strong feelings about the issue. Fair enough, but please le't not turn this into a bashing session. I've gotten so much good advice from everyone (UKRNinUSA included).
Augigi, I forgot to mention that the H2O2 is mixed in with normal saline. Does that make a difference? I didn't know that H2O2 caused fatal embolisms....makes me a bit nervous.