Accused by patient of stealing his percocet

[Nursebb1942]

The other night, I bent over backwards caring for this frequent-flyer drug seeker, making doctor calls, making sure his NPO status was removed the instant his testing was complete, diverting lab personnel so his labs could be drawn immediately, etc., etc. Nice as could be. Never had him as a pt before, but have seen him around. I served compassion with a smile and had my game on. My other patients were awesome, it was probably the best night I've had in a long time.

So...next morning, the day nurse tells me the pt accused me of not giving him his prn percocet at 0600! States he thinks I pocketed them, but that he "didn't see me do it." Then he apparently spent the day telling dialysis staff and whoever else he encountered that I had stolen his percocet. He was also caught smoking in the bathroom, but he lied and said he wasn't.

Fast forward, I came back and was supposed to be his nurse again, but I refused and switched his room with nurse K for a different one. Unfortunately, Nurse K had an issue as well. He was holding his percocet in his fist and would not open it and take the pills. he told her he had already taken them. So she told him she did not see him take them, and to open his hand. He refused. Finally he opens his hand, and oila! Two percocet. So he took them.

So anyway, I've been an RN for a year (LPN for 5 years before that) and this has never happened to me. Not sure what I should do. Thoughts?

Thanks,

Becky

[TheMoonisMyLantern, ADN, LPN, RN]

Yikes, situations like this are enough to make your skin crawl. With these types of patients your documentation is often your saving grace. When these behaviors occur it is IMPERATIVE to document exactly what happened so that in the event that administration investigates in complaints they have a written record of disruptive/non-compliant behaviors that allow them to see the complaints for what they really are.

Every situation is different, every facility is different, but I would be tempted to go ahead and let a supervisor know what happened, often times the first story you hear is the one you believe and I'm a firm believer in that saying.

Several years ago I had a patient similar to yours that accused me of never giving him his IV Dilaudid, the accusation was an attempt at manipulating staff into getting him an extra dose, as soon as he accused me I notified the supervisor and the attending physician this essentially "called his bluff." and he recanted his statements when confronted by the house supervisor and scowling attending.

Hang in there, and cross your fingers that he's discharged soon!

[Anna Flaxis, BSN, RN]

I probably wouldn't do anything at this point, since it is in the past and the information is second hand. If you are assigned to care for him again in the future, I would be sure to document behavioral observations- but do so as objectively as possible so as to avoid the appearance of bias. Document observations of actual behaviors, not interpretations of what those behaviors mean.

[FineAgain]

This has happened to me on several occasions by patients well known for this sort of antic. You must document of course, but the best way is to have someone witness, both by being present and signing on the E-MAR. The intent behind the behavior is to get more percocet but the ramifications (should someone believe the patient) can be totally detrimental. So worth the time it takes to get someone to witness.

[Been there,done that, ASN, RN]

Now you know that being "Nice as could be." Is not the way to handle drug seekers.

Being nice is viewed as a sign of weakness. You need to be firm and set clear limits.

Tell me you reported this to supervision!

[Farawyn]

This is why you stand and watch the patient take his/her pills every single time.

[xoemmylouox, ASN, RN]

That's frustrating. I would call your malpractice insurance just in case. I doubt anything will come of it, but it is worth it to CYA. As another person posted, being sweet and super nice to legit drug seekers is often seen as a sign of weakness. This doesn't mean that everyone looking for pain relief is a drug seeker, and that doesn't mean they will all try to play this game, buuuuuut now you know just how manipulative they can be. The same behavior can be seen in many inmates that injur themselves on purpose to get out of jail and into the ER.

[mmc51264, BSN, MSN, RN]

I had a pt accuse me of not giving a pt her narcotic pain meds, even though we have scanners and computers in the room. The pt's brother was in the room and was like "yea, I never saw you give it to her" Scared the living crap out of me. I documented immediately, called the doc on call immediately and told my charge nurse. The rest of that shift, I had my charge nurse accompany me to witness every narcotic administration. You never think about what people are capable of until they do something like that. Not losing my license for some piece of crap.

[Horseshoe, BSN, RN]

If that accusation ever made it into any documentation whatsoever, I would demand a drug screen for myself.

I'm sorry the OP and others posting here have had to endure that. How infuriating.

[Christine58]

WHAT is this world coming to????? First, ALWAYS document, document, document the factual situation as it developed and Second, report the situation to the supervisor, manager, physician immediately. Third, take a witness with you, & both sign the MAR, etc. until discharge or until another solution has been reached. Fourth, complete whatever Incident Report your facility has (in accordance with policy) as soon as possible - do not blow it off until the next day. Fifth, absolutely notify YOUR Liability Insurance carrier (every nurse should carry their own) just to make sure they are aware of what's going on at the earliest point in time, even if nothing comes of it. That's why you pay the premiums - for protection. Food for thought: Has the day arrived when we will be REQUESTING BODY CAMERAS to protect us all in what we do, say, etc. ??? Just saying ....Best of Luck and may the force be with you if this gets ugly.

[Anna Flaxis, BSN, RN]

Documenting hearsay (Nurse X told me that the patient told her that I did not give the ordered Percocet) in the medical record is not appropriate.

Documenting biased opinions (Patient is a frequent flyer drug seeker) in the medical record is also inappropriate.

If you are set on documenting this incident, you do have the option of doing so using the incident reporting system. You can file incident reports in retrospect at any time.

Typically, people who engage in this type of manipulative behavior show a pattern of behaviors that, when documented, speaks to their credibility in the event that they file a formal grievance. Lots of these folks can be pleasant and cooperative one moment, then turn on you the next. It's important to document a behavioral note on *every* patient, but on these folks in particular.

It could well be that this particular incident doesn't end up going anywhere. That is why I stated above that I probably wouldn't do anything in retrospect- you may choose differently. However, going into the future knowing this patient is capable of lying about medication administration and thus is capable of lying about anything, I would document every interaction - but again, keep it as objective as possible. Just stick to the facts and leave any judgment or bias out of it.

[NOADLS]

I had one of these patients years ago. The solution is easy.

Every time the patient has to take medication, two nurses or one nurse and another staff member stand there and witness the patient ingest the medication. If the patient refuses to comply, tell the patient that the doctor would discontinue the medication if there were any compliance issues. This also allows you to have an excuse in the event that you are late to getting this patient his or her meds as you can claim that there wasn't a second staff member available.

This might work as a deterrent for subsequent visits by drug seekers.