pain in the ed

so, what did we decide was the answer for the original question of this thread??

drive through percocet window?? not a bad idea, but unfortunately illegal in my state. I think the whole concept of pain in nursing is obviously a passionate one especially from those nurses who work in pain management.

Fortunately for me, I am not one of those nurses.. but I have been around the block or two and learned long ago that the patient doesnt have to prove to me that he/she is in pain, if they say they are in pain, then they are in pain. Short and simple. I think once you learn that you arent going to save the world and rehab all of the narcotic abusers, then your shift will go smoother and faster.

Sorry if I sound like I am patronizing the newer nurses.. We have chosen a career as a caregiver and so that is what we must do. When I worked med-surg and ICU/CCU I found that just being in the hospital creates pain and stress for some people, hence exacerbating whatever pain might be present for whatever problem.


But... I think this is a forum where we should be able to vent and complain without being persecuted..... just my two cents..

good post veetach - i agree -at work give 'em what they want - they leave much quieter - here i vent......

Pain management: the eternal ER conundrum. I do not want anyone to suffer pain. However, I don't always believe that opiates/narcotics/whatever are the solution to some patients' pain.

I believe there is a difference between acute and chronic pain. Acute pain needs to be treated as quickly and as effectively as possible. Same with chronic pain, although these days many patients with chronic pain do not hit the ER, they are being well managed by the pain specialists and generally do not run out of their medication when their providers aren't available.

Drug seekers are also in pain. But it's not the pain that will be relieved by another 'script for Lorcet and Soma or another Demerol 100 mg injection. Do I have any great insights about how to treat these patients in the ER - unfortunately, no. I do know it is costing the health care system $$$$$$$.

I try not to be cynical, but it's difficult to believe a patient who has a bp of 48/37 and is so obtunded she can hardly speak, but says that her pain is a 10 (I actually cared for this patient on Sat -gave her 10 mg of Narcan before she totally woke up). It's difficult to believe the patient who says his pain is a 10 who literally jumps off the stretcher one nano-second after getting his shot and says can I sign my papers now so I can go home? (Gee, I think you might want to stick around to see if the med actually works.) It's difficult to believe the four people who carpooled to the ER together, each with a migraine, you guessed it they're all 10s. It's difficult to believe the woman who comes to the ER every Sunday after church for a Demerol shot for her 10 headache. I could go on and on, but you get the picture.

My very favorite drug seeker was a woman who came to our ER with a fax from her doctor's office in another state with instructions for the ER doc to prescribe a certain amount of dilaudid. I tried to find the out-of-state doctor, the office, anything - didn't exist. When I told the family member who had given me the fax, he kind of shrugged his shoulders, smiled and said, well, can I have the paper back anyway?

Drug addiction is devastating to the patient, family, community, health care system (prison system too) and I hate to think that I'm helping to facilitate it. I mean I wouldn't give a liter of water to a patient on dialysis because he was thirsty, I wouldn't give a bag of m&ms to a diabetic patient, I wouldn't give a gun to a suicidal patient...

If anyone has any great suggestions or solutions, please share them.

Thanks for listening.

Just give them what they want, its easier than arguing with them. And your not going to cure or alter their problems in the ER, the best that might happen is the go to another ER, while theirs cone to us.
When a patient who is known as the worst drug addict you can imagine, can c/o to the state health department that we didnt treat his pain. This gives them the right to come in and tear through everything completely unannounced audit all your pain scale charts etc. Make yours everyones else life miserable for a few days. Why battle it, just give them what they want.

I disagree

Let's just give the shoplifter the merchandise he wants in the store then...

I agree with you, hogan4736... Many times at triage, I have been able to deter them, either by warning them of the rediculously long wait of "up to 6 or 8 hours" (when in reality it would be maybe 30 mins), or warning that the Doc on duty "rarely gives narcs but uses Toradol", etc...

On another note: Anyone have the unusual type of Doc that gives more effective pain med doses to the fakers than to the legit pts? IOW when the pt has legit pain complaints, they tend to be more "frugal" with the doses?

ERKev

Probably because tolerance issues and the fact that a "regular joe" would arrest if they got as much as a frequent flyer.. I know I have given doses that would kill me and my family...

It is frustrating and I remember being there and just getting ****** that this person was "wasting my time" ..anyone have any feasable ideas (Not the oxycontin lick in the waiting room)..on how to make this situation better? Erin

i think it is a catch 22 erin - if you treat everyone's pain equally - the seekers will keep coming back
if you don't treat pain equally - you run the risk of not treating a pt truly needing meds - you run the risk of getting sued -

i don't think there is an answer that can solve the problem of those who seek narc's from the ed....it's kinda like our freq fly drunks - no matter what they will come back -
the pain clinics are great - but those who are seeking still come to the ed (dog ate my med, ran out, somebody stole my med)

When I was a new grad in the ED, we used to keep a card file of our frequent fliers and share them with some of the other local EDs. Can't do that any longer though. It was nice! Just look up the name when you suspected drug seeking. Also good for other probs, like Van Munchousen By Proxy <sp?>...

Alas, the "Powers That Be" have put the kobash on that. It was a NICE referrence tool and did NOT result in people being dealt with impropperly, but allowed us to deal with them with KNOWLEDGE...

ERKev