pain in the ed

Hey all ed workers:

all I can add about addictions is : there but for the grace of god, go I. and my family. I do try to remember this when they are over-running the ed.
An interesting thing: we had a chronic pain patient who came to the ed frequently (like 1-2 times/week) and was medicated every time with what the doc thought appropriate- which differed greatly among docs. One day she didn't get "enough" and complained to (gasp) administratiion. They sent down the directive to the docs that they were to treat all pain...and not make any waves. The pt died of an overdose one week later at home. Now, guess what the administration is saying?
Wouldn't it be reasonable to have pain spec "on-call" and refer them to the spec., then NOT treat them in the ED, just like we do when someone breaks their ankle and calls the er for more pain meds? They are told to follow up with the orthopod...
However, my hot button is the ED pt who comes in and asks for their dilaudid cuz they are allergic to COMPAZINE, BENADRYL, DEMEROL, NSAIDS... then starts asking for a meal. we are generally EXTREMELY busy, and these folks aren't homeless and need a meal...and omigod can they *****!
This is a problem of society that we in the ed are paying for, in a lot of ways. Similar to the extensive advertising on TV by the drug companies, then the patients developing the sx and coming to the er asking for the drug by name. money shouod be spent getting more fam prac docs out there!

I agree...My mom worked ER over 20 yrs ago and it was happening then..I imagine in 20 yrs it will still be occurring. It is unfortunate but just the "way it is" I suspect.

When I left the ED a couple of years ago we could do a computer "run sheet" on pts..basically showed all ED visits from the last 2 yrs, diagnosis and meds given..I am not sure with Hippa whether or not it is still allowed or not? Erin

we use the computer run sheet also, but unless the docs all get on the same page, and treat the pts the same, it makes no difference. I think it's not a hippa violation, because it's "continuity of care". We have had the cooperation of pharmacies in the area, who are suspicious of Rxs that have been altered. But I wonder how many get thru? That's a good point about "not giving a liter of water to a dialysis pt"- I still think these are problems that can not be addressed in the er, however. But along with the over-crowding, holding pts, not being on by-pass, family members gone "berserk", and burnt out over-tired nurses, these drug seekers are difficult to handle. There is little left for them, I guess.

How about really really good staffing and lots of social workers and RNACS to help with insurance issues. I would find 2 or 3 hours to chat with the chronic pain med seeker to find out how they ended up in this mess. Then be able to suggest appropriate consults and actually get them.
With this understanding will I be able to help them? Maybe. Will I be able to redirect them? Maybe. Do they want to change? Maybe. But please give me the time to find out. And is there any other complaint that I have a sure 'I can fix it' answer to? Probably not; so why is chronic pain and pain med addiction such a problem?
As far as pain, I have personally experienced the headache after a skull fracture, that lasted about 6 months. I had grand-mal seizures for about 5 years starting 4 years after the skull fracture. Post-ictal sucks (so does wetting the bed as an adult)and it is really kinda scary as you wake up paranoid and ready to punch anyone who messes with you...,(must be some kind of survival instinct).
The pain of 2 fingers broken on my dominant hand was due to some sheep I had purchased to train boarder collies to teach hearding (second income). I had just left my ex and had 3 kids to support and my new nursing job didn't offer time off yet. I worked with this pain, my co-workers knew about the circumstances and helped a lot. Patients didn't know though as I was able to hide it without more than tylenol.
I had broken ribs and was a whiny mess for about 2 weeks, then I just dealt with it. (horse kicked me, owned the breeder mare and was checking out the filly, mare got ****** and kicked me)
I dislocated my hip, knee and ankle in a horse riding accident. Walking on crutches at school for 4 weeks was excrutiating, I messed up on 2 tests as the pain had my mind in a head-lock. Another girl in school was also on crutches for an injury but she didn't look as messed up as me. I figured there was something wrong with me as I had so much pain and she was just cruising through stuff. I found out later she had twisted an ankle and her dad was a sports medicine PA so she got the crutches so she didn't do further soft tissue injury.
I have many other personal pain stories (I love life and things it offers), but my job dosen't let me talk to someone in pain because 12 others have to (one of the following) pee, get to bed, go to beauty shop, call family member, need pain meds, afraid, nauseated need medicated, bed isn't made, need bedpan, need off bed pan, climbing out of bed, climbing out of chair, phone call from family, phone call from doctor, phone call from supervisor on need for more staffing-is this real or can you deal with it. At this point I am gonna say yes get me staff or I am going home.
Give me enough staff to do what I am trained and experienced to do PROPERLY!!!! I believe pain, I understand pain, I know that emotional circumstances can elevate or deflate pain. Addiction reduces pain to someone elses concept, can an addict convince someone to give the medication that they are seeking. What the addicted person is feeling or why they need the medication takes too long for us to listen to and the addict needs the medication NOW...then no need to chat about it until the next fix is needed.
OK my venting finished.

and that's exactly what i mean with "there but for the grace of god, go I" people have pain, whether real or really real, it's all the same to them I am lucky not to be in pain, addicted, drunk, or homeless.

I agree, there but for the grace of God go I, or my family. However, I have a strong feeling about enabling negative behaviors. People do what they do because they can, and it works. Our ED only sees 25K pts /yr so we have the luxury of doing some police-ing. We, and some of the smaller ED's around us have a "special needs" list. So far that seems to be flying around HIPPA and our MD's are willing to call one another with problem pts. We also document the Rx's given to all pts in our computerized ED log, that gives us a quick way to spot "seekers".
There are no easy answers, but I'm not willing to give up and roll over, (that is what the seekers are counting on) just because the problem seems overwhelming.

No way

Ahh, yes

It seems teeituptom is doing a lot of "rolling over"

Sean