I am a PCT at a hospital and i just got home from work and experienced a situation that I would like the opinion of outside parties on. A patient has been in our care for several days for pain control of a type I chiari malformation. The pt has orders for 2mg dilaudid q2 which she receives constantly (literally 24mg in a days time) as her pain is always a 10/10, etc. I mean the kind of pt that will set a timer on their phone to go off every two hours so that they may ask for pain meds. Essentially this pt has not slept for the three days she has been with us because she is always, always asking for (and receiving) dilaudid day and night.
Her vitals are fine every time they are checked (which, by our policy, is 30 min after every admin of dilaudid; pt also kept on continuous pulse ox) but is clearly "high" off the meds. Slurred speech, stumbling gait, can hardly keep her eyes open, cant recall her last med time. what really drove me to write all of this, however, was what happened this past evening. The pt wandered out of her room topless (no gown, no shirt, no bra) and just in pants looking for the RN.
Upon discovery she was immediately helped back to her room and attempted to be reoriented. I believe (but am not 100% sure) the nurse then held her next dose of dilaudid. at the next scheduled time the RN definitely administered it. The way this case has been handled does not seem right to me at all.
It seems we are clearly encouraging what appears to be drug abuse and not considering any other options nor treating current problems properly. Please advice and opinions, because as a future nurse, I would not be simply following the others and continuing to give the drug to please the pt. Thank you!