Same patient's over and over again - Page 5

I've always considered frequent flyers = guaranteed job security and easy report as we know them so well.
Once I started in homecare weekdays and hospital on WE, saw a different side of their personality when they were in home environment.

Education and positive reinforcement is the key. My nephew with diabetic gastroparesis had 50 admits in 2010 and 2011 with severe DKA, septic ICU, + MRSA. Nurses wrote him off untl ICU staff met me one night and they realized he DID have a family member who cared. I educated them on steps he was taking to try and get handle on disease. Change in lifestyle + living situation with a family member that cooks for his needs, found gainful employment and has stayed out of hospital x 5 months now.

This thread makes me wonder about the thoughts of the nurses involved in my mother's "frequent flyer" days. Of course, everyone will say her situation was "different" because she was FINALLY diagnosed with liver cancer 2 months before she died. We did pain management at home but there were times when the limited meds we had just weren't enough and the pain got so bad we'd make a trip to the local ER. I tried for months and months to get her on hospice but was only able to do so for the last 13 days of her life. By then things had gotten to the point where she was given 20mg of Roxanol every hour around the clock....needless to say, I didn't get much sleep for those 2 weeks. Looking back on it, there was that "oh crap here we go again" attitude from several of the ER nurses. Eventually they came to realize that she was there for a legitimate reason and their attitudes did change but it still hurt to be almost dismissed by them, and treated as if we were a nuisance.

One doc though, stands out in my mind. Mom was stuck back in the little room in the corner that was mainly used as a storage room and the doc came in, sat down and talked to both of us for quite a while. We explained what was going on at that particular time and he said that he had reviewed her chart and would do what he could. I then overheard him tell one of the nurses in the hall "Give her whatever she needs, however often she needs it. This lady is never going to get better but we need to do all we can while we can." He then came in, said she'd be given pain meds and asked her if she felt she needed to be admitted for further management. By morning, she was feeling better, the pain was more manageable and no admit was needed but God bless him, he was our hero that night.

There is always more to the story and a history. Some Nurses need to not judge so harshly or harbour preconceived notions.

My niece a few weeks a go went to the ED for kidney stones. This has been plaguing her for some time now(awaiting nephrology consult) Her Mom (a nurse) was OOT (my niece is 21 at college, 21) So...She called my sister (a nurse as well) because she was in pain and she was told that they would only give her Advil because she has been seen for this in the past. My sister went to the ED and was outraged at the behavior of the ED nurses indicating my niece was drug seeking....being a college town and all......that went the did the CT (with my sister insistence) they found a 6.5mm stone obstructing her R kidney.

A they puked all over themselves apologizing, including the MD, and started an IV for meds and arranged for admission......we as Nurses need to remember to take the time and REALLY listen to our patients and REALLY assess them and not be so quick to judge.

I work in oncology so quite frequently I do know the patients. I have some sort of knowledge of their issues and attitudes. Sometimes it makes the job easier.

For the record, suboxone copays are not cheap. And drugs are. Far, far from 100's of dollars a day. A hyperbole like that IS coming off as judgemental.

Would be better if it was just "non-emergent" whether they have insurance or not.

I meant to include the insured too!

Want to know what our ER looked like last night? 3 chest pains, 2 MVAs, potential miscarriage, kidney stone obstruction, 2 lacerations from using power tools/yard work. All legit reasons to hit the ER. 8 patients. Unfortunately, we had 25 others that were earache (in an adult), headache, foot pain (gout and won't take his meds), belly pain with intractable n/v/d (abd. series showed this guy was literally full of formed stool -- he couldn't possibly have had diarrhea, and when the doc challenged him on it, the moaning stopped, he hopped up, grabbed his clothes and left), drunk, drunk, and another drunk, a bunch of people who were coming down from being stoned and wanted our meds to stay stoned, 3 LOL from the local nursing home with UTIs - not septic, only symptom was pain on urination and cloudy urine, could have called the MD for antibiotics, but sent them in. We were having families come in as a group, all complaining of pain somewhere, no scripts for narcotics, and everybody's drug screen was positive. It went on and on for things that the average person (me) would have either handled OTC, asked the doc to call something in until I could see them Monday

You want to keep ERs open? If you test positive for an illegal drug and you're not a trauma patient and your EKG's negative, see your doctor in the morning at their office. We can't afford to keep doing what we're doing.

For the record, I've been told by patients that their co-pay on Medicaid is $20. The highest I've heard is $35 for BC/BS. I've been told by patients that they sell their Suboxone for $25 dollars a piece to buy other drugs.

Pt's are very frequently on probation for stealing. Have stolen everything they could from their families, have stolen money out of their family's accounts, using credit cards, forging checks and put them into bankruptcy.

Have sold their bodies to support their habit. Hospitalized drug addicts DO spend $100 to $200 or more dollars a day on drugs. Drugs are not cheap.

They use 200 to 400 mg of morphine IV per day. A gram or more of cocaine per day. 50 to 100 mg of Dilaudid IV per day. 15-20 Oxy's, Roxy's, Percocet's, Lortab's per day in addition to large amounts of Xanax, Valium, Ativan. The amounts they use are mind-boggling.

Drug addicts are far more likely to fatally OD after being released. They have been detoxed and when they relapse immediately and go back to using the amount of drugs they were using, it kills them, the same as it would someone who has never used drugs.

This is not called being judgmental, these are the facts. Their drug screens are positive for at least 3 or 4 different drugs.

As a nurse, it's our duty to give these patients competent and compassionate care but it does not mean that I have to look past the fact that they are sucking the life out of our healthcare system, welfare system, etc...not to mention they are out there driving amongst us, our children and our families.

I confirmed this with a former addict. This person said $60 for 90 pills vs. $140/day for about 1g of heroin. I stand corrected...and shocked.

Also confirmed that suboxones are resold for $15-$25/pill which is such a shame for those people who are actually trying to get on the wagon.