Interview Q. re Post-Op Addiction

[Fancypants09]

Hi all,

I was interviewed recently for a surgical unit.

One of the interview questions went something like: "Mrs. X reports pain, you go to dispense pain medication, but the other nurses on the floor are worried that said patient is addicted to pain killers, how do you proceed?"

This question kind of stumped me, so my answer was a bit hackneyed, but I tried to answer as best I could. I said something along the lines of researching pt's previous med history, talking to pt's physician, and looking at trend of medication administration for the duration of time that pt has been on the unit. I know that, statistically, chances of opiate addiction in post-op pts are very low (less than 10% I believe), although pt may fear becoming addicted - so this would require pt teaching regarding dependence, tolerance, and addiction as being separate entities.

What are your thoughts on this? I don't know how else I could have answered this q differently, it's been bugging me! Thanks so much!

[brownbook]

You can ask 10 people this question and get 20 answers!

I would have said something about if it was time for her next scheduled dose of pain med, if her vital signs were stable, O2 sat, level of consciousness, etc. were within normal limits, I would have given the Dr. ordered pain med.

My gut reasoning, (I might not say this), is that unless I'm working in a drug rehab clinic, a patient's pain is what they say it is. If they are medically stable then they receive their routine next scheduled dose of pain med. I'm not going to listen to other nurses gossip!

[smf0903]

I follow the philosophy of my very first clinical instructor. She always told us that we will encounter stigma in the workplace when it comes to patients who are drug abusers/seekers. When a patient reports pain and has pain meds on board, treat the pain. Just because someone may be--or even actually IS--an addict, doesn't mean they somehow don't experience pain post-op. My concern would be pain meds not "cutting it" because of possible tolerance. That clinical instructor always said "treat the patient for what they are there for". If they are there for post-op pain, treat their post-op pain. Treating their addiction is another visit.

[cayenne06, MSN, CNM]

I want to echo smf0903. We worry, of course, about our impact on addiction rates as health care providers. We don't want to contribute to the problem. But in an acute pain situation, a patient's potential status as a closet addict is really neither here nor there- EXCEPT to make a note that they may require additional medication due to tolerance and increased pain perception.

I would have responded with something along the lines of "In that situation, I would be sure to watch closely for response to medication, with the knowledge that people who have opioid dependencies often require more aggressive pharmacologic management, and can benefit from non-opioid strategies like nerve blocks. I would thank the nurse for sharing her concerns and ask her what she saw that elicited her concerns. I would be sure to assess for signs of dependency or addiction, and pass along any concerns I might have to the patient's provider. I would also consider discussing this with the nurse educator, if I thought that the unit as a whole would benefit from more training in caring for potentially drug dependent patients."

Drug dependent patients need good pain control. Inadequate inpatient pain control is a risk factor for relapse and rebound overdose. Be careful about the rx's you send people home with and be generous with your post op pain relief. In my opinion.

The last thing drug dependent people need is more judgment and stigma. Nobody deserves to suffer in pain, or have their subjective report of pain be dismissed, just because they have a chemical dependency. Being a drug addict suuuucks. Skating withdrawal and suffering through post op pain, in a scary and unfamiliar hospital room... that sounds really unfun. NOT the time to try and address a dependency issue.