abusers and losers. Can you top this one?

[Uptoherern]

Last monday, I had a lady come into triage with a godawful, pity-me limp. She proceeded to tell me that she had terrible pain from her low back radiating into her left leg. She offered up that maybe she had "over done it at her family picnic" the morning before. Then she said, "I think it might be sciatica!" (stage limp = 1st red flag, medical jargon from non-medical person = 2nd red flag). For some unknown reason, she felt she needed to share that she had had an MRI the previous thursday, but her Dr. didn't have the results yet. Now I am confused beyond reason....why did she have the MRI thursday, when the pain started Sunday am? (red flag #3). I simply told her that since it was now Monday, I would place her in a room, and call her PCP for the MRI results. Looking a bit nervous, she allowed me to place her in a room. I told her to get into a gown, and the Dr. would be in to see her shortly. She did get into the gown, then opened the door and laid back onto the cart. I called her PCP, and they said they would get back to me. A few minutes later, one of the nurses said, "Diane, you have a phone call from dr. so and so's office regarding the lady in bed #3". As I go to answer the phone, the patient appears on the other side of the desk, fully clothed (nt having seen the er dr yet), and proceeds into this tearful tyrant about her PCP having "washed his hands of me!" boo, hoo. As I am looking at her, her dr.'s office informs me that this lady did indeed have an MRI in April, however it was in 2002. I thank them, and hang up. Then the pt. tell me that her "othopedist" (red flag #45) "told me that if EVERYBODY in the world was taking oxycontin, then who would be left to govern the world?!!!" boo, hoo, hoo. I tell her, she hasn't even yet seen the ER dr. Would she like to return to her room to see him? She sniffs a few times, and goes into the room, only to return to the nurses desk a minute later, saying "I want to sign out AMA!" (another one of those medical jargon red flags". So, we sign her out...and upon cleaning the room, discover that the code cart key is broken, and the pre-filled valium syringes are gone. Great. BTW, another thing she had said in triage was "My co-worker dropped me off during my lunch break and will pick me up when I'm done" I hadn't even asked her how she got to the ER. She obviously Knew enough to say that, so that if she got narcs, we would think she had a ride. When she signed out AMA, she had her car keys in her hand.

Call me....MS suspicious

I shoulda been a cop

[canoehead, BSN, RN]

Ha! Excellent bulldust detector there, RN!

[canoehead, BSN, RN]

Ha! Excellent bulldust detector there, RN!

[debi87021]

It seems to me that all ED's get those frequent flyers, and seekers. I agree that nurses seem to have this nack for busting the liars. My seekers are usually allergic to toradol, motrin, and tylenol. I had a women once, in again for migraine, 3rd time in one day, anyway, doc told her she would get demerol shot, ordered toradol, Patient left without any allergic symptoms and no pain 10 minutes after the IM toradol. Two days later she was sent into rehab. (she was hospital employee).

Also, i haven't noticed a nurse yet that refused care to a patient in need of pain control. We always give them something, just not always narc's, and sometimes i think it is for the best to try other methods before narc's. I know what pain is too, after 2 major abd surgeries, i know all to well. But i found it was easier to get non narcotics, and i felt better, then later the doc would be all too happy to give the narcs if non narcs didn't help. just my opinion.

[Uptoherern, RN]

What about this situation....one of our ER doc's will tell pt.s that he suspects of drug-seeking that he will give them a pain shot. He then tells the nurse to draw up a dose of "nackle", spelled NaCl-.....wink, wink, nudge, nudge. It is, of course, just normal saline. I don/t feel real comfortable doing this. What do I say if someone should ask what exactly is it? Alot of drug seekers want to know exactly what they are getting ("demerol?, how many miligrams is it? Did he give me Phenergan with it too?" Has anyone else dealt with something like this?

[caroladybelle, BSN, RN]

Tell MD to give it himself - not my job to fudge.

[prmenrs, RN]

I think that is considered illegal and unethical. I have the greatest respect for the BS meter, but I don't think you should lie to the pts. And don't forget the placebo effect--even sugar pills DO work sometimes if the pt. thinks it will.

JMHO

[gwenith, BSN, RN]

It is considered illegal to give placebos over here. I do not know if it enshrined in statute or if it is just considered fraud. I would tell hime that if he wants to decieve a patient he can DIY.

I agree with PRMENRS the placebo effect works well but you Can use it on "real" meds. I give them panadol and talk about establishing a "background level of pain relief" or creating a "synergistic effect" with existing medications. Trick is you have to say as if you believe it and this has just enough credibility to be believable (it's not that it is untrue it is just that it is not as effective as you are about to convince them). A lot of frequent flyers crave the attentions as much as the meds and this sort of approach keeps them very happy while convincing them that you have thier best interests at heart.

[AZEMS]

ER-ED "everyone requesting every drug"

I'm from phoenix also and its horrible out her. I see mom-daughter combination seekers in the ER every three days.

my only response document and destroy. Sign Rx with phone #'s instead of DEA #'s verify the pts. RX history with pharamacy. Refer to pain mgt. with only 2-3 day supply of pain meds.

Inform pts with pcp's thet will be called about there "problem" event. Tell frequent non-urgent flyers without obvious disfunction

long wait related to frequent problem and poor follow-up place them in lower priorty levels and inform your chrg nurse. get them there w/c to help get them out of a car then place them in a seat and tell me you need it for the next pt to be assisted its the only w/c for transport.

only through our critical thinking and appropriate actions and documentation could we defend, diminsh, and destroy seeking behaviors

[AngelGirl]

I agree with AZEMS that drug seeking behaviour should be addressed, using a "team" approach.

The abuser returns to the ER lottery, night after night, hoping to score the BIG one, if, perchance, his/her favorite health care provider is working. This provider tends to ignore the limits set by previous providers and simply opens the candy drawer to give out any med the pt. wants.

Until providers use a team approach and give out ONE, only ONE Motrin, then dc to home, the abusers will continue to plague our ERs.

[Robinellah]

I think your ER doc is a jerk. To give saline and suggest that they are getting pain medication is a wonderful way to lose your pt trust. If it is not illegal it should be.

He should be called in to answer any questions that the patient may have about what the medication is and what it is used for and if he lies to the patient he should be reported to the Medical Board....he gives docs a bad name. I wouldn't give the medication under false pretenses.

[teeituptom, BSN, RN]

Hi Ya'll

After many years of debating the pain control issue. and the frequent flyer issue. and the abuser issue. Maybe I should say decades now. Multiple, ahh well. I have the easiest and least stressfull way to deal with this issue. Leave it to the doctor to decide, how he wants to handle it.

If someone is fraudently using the ER to obtain narcotics, what can you do. Can you notify the police. No Its a HIPPA violation.

If someone is faking pain to obtain scripts. If you deny them pain control even if it is all subjective they can notify and you can be spot inspected for this by the state health department, or whoever they complain to.

Is it worth the stress you inflict on yourself to fight this issue, Not really. Been there done that too.

Been chewed on by administration over this issue.

Why fight it, The victories are too few and the satisfaction too little.

[Robinellah]

I work for a pain management doc and see a lot of drug seekers/abusers.

It always seems like the one that you doubt the most is the

one who inevitable has cancer that has metastasized or

herniated disc flattening their spinal cord or some such very painful physical problem.

Alot of the time they are addicted by the time they see us just from the meds they are prescribed for chronic painby their GP.

The tolerance that is built never stops amazing me. I don't know why half of them are not dead from the sheer quantity of "dope" that they are taking. Yet they continue to walk thru the door...Scary part is they normally drive themselves...

We actually drug test some of our patients to make sure that they have pain meds in their system.

We have pts on Oxy and MS Contin that test clean.

Some of them have had these meds prescribed for years for what the diagnostic tests show to be a very painful lesion or whatever.

But basically they don't hurt enough to take their pain meds.

When we find one like that we take that many drugs off the streets. Talk about a war on drugs.

It's a lose lose situation.

And as someone else mentioned...we are not going to cure their drug addiction.

Pain is subjective.

Sorry I am rambling...2 am and beat down. heading to bed.

Have a good day all...

Robin