No pain meds for drug-seekers?

Thedreamer · Jul 2, 2007

Um.. to me that sounds like neglect. You cant possibly feel someone elses pain. At our hospital if they say they have pain you have to assume they are in pain and medicate accordingly.

Now the only exception is that if they come in and tell you that "Oh i have back pain and tylenol doesnt work.. they give me that thing thats um.. D... Dem.... demril?" (they mean demerol) and they look 21 and never worked a day in thier life, then you might have the doc prescribe a pain killer thats very low dose..

But never EVER would I mark a patient for 0 in pain when they say they have higher.. Thats asking for your lisence to be revoked imo.

Megsd, BSN, RN · Jul 2, 2007

But never EVER would I mark a patient for 0 in pain when they say they have higher.. Thats asking for your lisence to be revoked imo.

The thing is, she's not telling me to assess and mark zero anyway. She's telling me NOT to assess if we suspect drug-seeking and just mark zero if they look like they're not in pain.

It's STILL asking for my license to be revoked, though, I feel, because if they ever audited that chart and somehow asked the pt if their pain was assessed every four hours, they could say no, but I charted I assessed it anyway, so I falsified the document.

But as a student I don't know how comfortable I feel rocking the boat and getting a second opinion from another instructor, you know?

leslie :-D · Jul 2, 2007

you need to familiarize yourself with the "pts bill of rights".

this is unethical as well as negligent.

chronic med-seekers are a challenging pt population.

but they still have rights, just like everyone else.

leslie

Thedreamer · Jul 2, 2007

Well I have had my own bouts with ethical conduct and students/instructors not acting up to par. In the end you are the patients advocate, only you sometimes. I always always always fight on the side of my patient vs anyone else because they are the ones in pain or injured or lonely.. Being their caregiver means you can empathize for them and you're going to try your best to make them better. Its about the trust and faith they put in you!

I dare any instructor to tell you that assessing pain on a patient is wrong if they suspect drug seeking behavior. You are their advocate and to be anything else is negligent. Present those apples to any logical person and they cant possibly tell you you're wrong.

Im sorry if i come off as strong about this but I believe very strongly in advocating for our patients! Its their right to be pain free and feel safe and secure with you helping them in their time of need. No instructor should ever get in the middle of that.

GratefulHeart · Jul 2, 2007

I'm had my general orientation for my psych rotation today. I heard some advice from my clinical instructor that is not sitting well with me and I am hoping for some feedback so I can handle the situation appropriately.
We were talking about pain management and how it is mandatory to assess pain every 4 hours. My CI told us to go ahead and do a pain assessment and intervention in the morning, but for the noon assessment "if they're a drug seeker -- and you can spot a drug seeker -- just mark them as a zero for pain if they look ok" because "if they're just looking for drugs you don't want to give them the meds they want every 4 hours, do you?"
We have been taught repeatedly in every nursing class that pain is a subjective experience, that we must assess pain and if the pt says they are in pain, we must intervene. Marking zero on a pain scale because my pt "looks ok" and is supposedly only going to report pain in order to get drugs sounds really unethical to me, but my CI assures us that "psych is different" and we need to remember that. I asked if we should be asking our RN before every pain assessment whether we need to do one and she said we only need to skip the pain assessment if the staff says the pt is a drug-seeker.
So do I do as my CI says and deny pain meds to drug seekers, or do I go with what I have been taught in every other course and give pain meds if pt states they are in pain?

Hmmmm. I wonder what the staff and your CI would think if you charted that you'd asked the patient to rate their pain, and they'd said it was a _________ on the pain scale, but you didn't give them any pain meds because the staff and your CI told you not to since the patient is considered a drug seeker? That would create a bit of a problem for everyone, wouldn't it?

I empathize with your discomfort and not knowing the best way to respond. This is definitely one of those times when I'd go discuss the situation in private with another nursing instructor in the program whose nursing ethics, wisdom, and experience I trust. Ask for their perspective and share with them what your thoughts/feelings are. Through the discussion you may gain some take on this that will then help you know what to do.

BTW, I'm with you...pain is whatever the patient says it is (and should be treated appropriately). However, I think a wise advisor can help with how to respectfully/tactfully respond to the CI and staff while you continue to advocate for the patient.

GingerSue · Jul 2, 2007

?
...pain is whatever the patient says it is (and should be treated appropriately).
Is it really a problem to give pain medication to the patient?
Has the patient been informed of the expected response, if he/she next requests pain medication?
If this person is having pain - then appropriate treatment should be arranged.
If pain medication isn't acceptable to the staff or CI - then perhaps more effective treatment needs to be arranged? Perhaps more effective assessment and planning needs to be done re: this specific patient's circumstances.

Megsd, BSN, RN · Jul 2, 2007

Hmmmm. I wonder what the staff and your CI would think if you charted that you'd asked the patient to rate their pain, and they'd said it was a _________ on the pain scale, but you didn't give them any pain meds because the staff and your CI told you not to since the patient is considered a drug seeker? That would create a bit of a problem for everyone, wouldn't it?
I empathize with your discomfort and not knowing the best way to respond. This is definitely one of those times when I'd go discuss the situation in private with another nursing instructor in the program whose nursing ethics, wisdom, and experience I trust. Ask for their perspective and share with them what your thoughts/feelings are. Through the discussion you may gain some take on this that will then help you know what to do.
BTW, I'm with you...pain is whatever the patient says it is (and should be treated appropriately). However, I think a wise advisor can help with how to respectfully/tactfully respond to the CI and staff while you continue to advocate for the patient.

Yeah, exactly. Though since my CI has to approve all my charting I doubt the "I wanted to give pain meds but my CI won't let me" nursing note would be vetoed, unfortunately.

I will consider going to another nursing instructor about this issue. I feel it puts me in quite an awkward position. I know that the more I worry about it the less likely it is that the situation will come up, but I'd still feel better knowing how to appropriately respond. I don't feel it's my responsibility, or my right (or my CI's right) to point out who's just looking for a high versus who's in pain.

I'm glad that my gut was right that this was wrong and that I'm not just overreacting.

Thedreamer · Jul 2, 2007

Surely other students in your class didnt sit well with this mandate? Id be scared to be her patient and need pain medication because I dont show alot of pain in my expression but I can be having terrible pain...

CarVsTree · Jul 2, 2007

I'm sorry this is happening to you as a student. You are in a very precarious situation in terms of speaking up. I would bring it up in lecture. Ask the question innocently, "we were in clinical and were told to not assess pain at 1200 on "drug seekers" and chart 0/10 if the pt. "looks alright," isn't pain subjective and whatever the pt. says it is?

Now for the real world. When I have a pt. that I doubt is in as much pain as they are proclaiming, I still document their pain as they describe it, for example 10/10, but if pt. is telling me 10/10 then nods out I chart that. I had a teenage girl who was on a dilaudid PCA (which was way too much for her, she was very somnolent) but family was causing a lot of problem. I believe they were instructing her to always say her pain was 10/10 so we would give her more pain meds. I'd ask how her pain was, she'd barely open her eyes say 9 or 10 and fall back to sleep. I also suspected family was pressing her button. Needless to say it was a mess. I had a long talk with Mom knowing the PCA was going to be decreased the next day for ambulation. Stating with this much narcotics she would not be able to recover. It was challenging, but because of my careful documentation we painted a picture without ever accusing pt. of "inflating her pain score."

Don't know if that helps, but you need to give pain meds when patients complain of pain, but when things just seem very suspicious, you just chart the facts, not your opinion or suspicion.

But you NEVER lie about it. That's begging for a lawsuit and it is just plain wrong.

danissa, LPN, LVN · Jul 2, 2007

Genuine Chronic pain sufferers, (my mum included) know when to take their meds, and what they need to keep on top of things so they dont bite your head off. Since she is in hospital this week, took a wee bit of shuffling to get her meds right for her, now they are, its a relief.

Don't EVER..EVER falsify a pain score based on how the ptient is looking..my Mum tries her Hardest to be cheery and never bite the head off a person, but inside the pain eats her up. ALWAYS trust your knowledge of a patient, and HEAR what they are telling you! Would hate to think that someone was thinkin that my dear Mum was faking, just lookin for extra meds..this is a decent woman who happens to have chronic pain! BUT..she smiles at every new person she meets..thats just her!

luvschoolnursing, LPN · Jul 2, 2007

Pain is what the patient sayes it is

Along with the 5 rights of medication I think I heard that more in nursing school than anything else. It is not our job to determine the patients pain. If they are in psych, there should be physicians who are determining if they are drug seeking and dealing with it appropriately (I know this is often wishful thinking)

You need to assess the pain, document it and report to the patients primary nurse or physician if you think he/she requests more than seems right. I agree with the above poster that said speak to another instructior in your school that you trust because as a student, unfortunately, if you get on the wrong side of this instructor by going directly against what she tells you too, you may have a rough semester.