pain in the ed

[MAGIK GIRL]

i am wondering if a percocet or an oxycontin drive thru right in the waiting room would be the answer. then perhaps, we would have the time to give quality care to our patients who are really sick.

our er uses the pixis and computerized mar's. the doc orders a drug, you have to wait, wait, wait, and then go to the pixis, get a witness for a waste (if you don't need all of the pre measured dose), and then give the pain patient his dose. never mind the fact that on the way to the pixis you have 6 other things that suddenly need to be done and that pain patient has sent each of his 6 visitors individually at 5 minuet intervals to complain that the 2 hour er stay is rediculous and that he missed his dinner and wants you to fix him something to eat.

by the time you get to the patient, the award winning draumatic preformance is simply breath taking!

now i know that some pain is true. but if i have a kidney stone, an acute appendix, labor pains, or chest pain, the er nurse shouldn't have to come out to the smoking area, tell me to put out my cigarrette, put down my big mac and accompany her to a room where my vs are 120/80 - 70 - 16!

thanks for allowing a "newbw" to vent!

[teeituptom, BSN, RN]

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.

[hogan4736, BSN, RN]

Originally posted by teeituptom

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...

[ERKev]

Originally posted by hogan4736

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

[Erin RN]

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 pissed 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

[athomas91]

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)

[ERKev]

Originally posted by Erin RN

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 pissed 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

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

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

[erjulie]

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!

[Erin RN]

Originally posted by athomas91

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)

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.

[Erin RN]

Originally posted by ERKev

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

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

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

[erjulie]

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.

[MAGIK GIRL]

Originally posted by Erin RN

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

i think that the "visit history" with the reason for the visit only is ok. the good old seeker files are unfortunatly a thing of the past. it surely is a hippa violation to lable any one (not to mention the discrimination law suits that could stem from that). if you put the complaint and treatment meds on the sheet that can be construed as leading people to think a certain way about someone.

in the first er that i worked in, we used to have a recipe sized file box. we would stamp the persons name and write the date of the visit. we would also write down any pertinent events with the visit. as a matter of fact, when i oriented many years ago, i was shown the file and told, "if anyone comes in for any kind of pain, check this file. it the person has a card, put it on top of the chart and then in the to be seen rack!"

yipes!

[stressednurse]

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 pissed 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.