Accused of not giving dilaudid

[KMULL002, BSN]

I had the misfortune of taking care of a patient last weekend. This patient was a friend of mine that I have not associated with in years. This acquaintance is the type of person who called the cops on a restaurant due to they added the tip into her bill and she didn't want to pay. One of the reasons I stopped hanging out with her was due to she would ALWAYS complain about poor service when we went out to eat; the most memorable experience my birthday was ruined due to her complaining about the service at a restaurant that was fabulous. I met her at a salon and she had started doing my hair and we became acquaintances/friends. She brought me Thanksgiving dinner when I had to work a few years ago. So, she's my patient last weekend. She had her arm bent showing me pictures of the gas station where she fell and broke her arm meanwhile telling me she has a lawyer. I asked her to straighten her arm because the IV was in her AC so she did and I administered 1mg dilaudid. The MD that same day increased the dilaudid dosage from 1mg to 1.5mg but the day shift rn told me in bedside handover report that the patient did not want 1.5 md she only used/wanted 1mg. I asked her if she wanted 1mg or 1.5mg and she said she only wanted 1mg. I gave 1mg dilaudid and then flushed her. She continued telling me her story and the flush syringe fell off bed; patient's husband pointed that out. I found out after the fact that this patient put up a big stink the last time she was admitted for hip surgery posting two nurses names on Facebook saying they were not compassionate etc one of the nurses I was working with that night is one that the patient posted about on FB; she told me she would not ever take care of said patient and because of said patient she switched from full to part time she also told me that another nurse who is a day shift charge quit over that same patient but later came back. I said to myself I wish I had known this before I took this patient. Well back to my point, this patient stated after I gave her the 1mg dilaudid that she didn't feel it. I offered the extra 0.5 mg (which would be 1/2 of the 1mg syringe) and she agreed to take it; I gave it to her. After all this the patient calls my charge nurse to tell her she can't believe I did this to her accusing me of not giving it to her I guess. After I left the room I wasted the 0.5 mg left in the syringe. My question is, how do I prevent someone from accusing me of not giving them their medicine. My thought is that I tell them when I give it to them that I am giving them the 1mg of dilaudid right now. Do I always bring a witness? I wish we could wear cameras. Make a point of verbalizing what I'm doing. Any suggestions? This has bothered me. the patient posted on FB negative things about the hospital and my cohorts about her last stay and the hospital apologized to her. This experience is making me question my career choice. To this day I have thoroughly enjoyed nursing. I LOVE nursing. I love teaching nursing. I love my coworkers and the clients I serve. How do I not allow this experience to taint my satisfaction and love of the field? Can someone's claim be substantiated even if it's false and I lose my license?

Thank you.

P.s. It is my goal to further my education (current BSN want MSN in clinical nurse education) because I love nursing and education so much. I intend on always having hands on nursing care but want to teach too. Just and FYI.

[LovingLife123]

Let her complain. You gave it to her. You wasted the remaining. People complain all of the time. This won't be your last complaint.

You just need to let this roll off your back.

[Sour Lemon]

Ask that the assignment be changed when you discover a patient is someone you've had a personal relationship with. 99% of the time, it can be. And yes, when you're dealing with someone dramatic and accusatory, always bring a witness along. Every time.

[Davey Do]

This sounds like an interesting scenario but I'm still confused, even after paragraphing your post.

Bottom lone: Your professional, objectively documented word against hers.

Good luck to you. Let us know how this all pans out.

[macawake, MSN]

KMULL002 said:

I found out after the fact that this patient put up a big stink the last time she was admitted for hip surgery posting two nurses names on Facebook saying they were not compassionate etc one of the nurses I was working with that night is one that the patient posted about on FB; she told me she would not ever take care of said patient and because of said patient she switched from full to part time she also told me that another nurse who is a day shift charge quit over that same patient but later came back. I said to myself I wish I had known this before I took this patient.

Your two coworkers sound quite dramatic and frankly thin-skinned. I don't understand how a single challenging patient hospitalized for what must have been for a relatively brief period of time for a hip surgery, could make one nurse quit her job altogether and another switch from full time to part time. That seems like a massive overreaction. It seems both you and your coworkers give this patient way too much power.

KMULL002 said:

This experience is making me question my career choice. To this day I have thoroughly enjoyed nursing. I LOVE nursing. I love teaching nursing. I love my coworkers and the clients I serve. How do I not allow this experience to taint my satisfaction and love of the field?

You've been a member here since 2006. Have you been a nurse for all that time? I don't think you should let one demanding patient question your entire career. Frankly, I'm very surprised if this is first time you've encountered a difficult patient. We deal with all of humanity and are bound to see all sorts of behavior.

KMULL002 said:

My question is, how do I prevent someone from accusing me of not giving them their medicine. My thought is that I tell them when I give it to them that I am giving them the 1mg of dilaudid right now. Do I always bring a witness? I wish we could wear cameras. Make a point of verbalizing what I'm doing. Any suggestions?

Back when I did floor nursing, if a specific patient acted out in ways that made me worry that they were capable of lying about the care they received, I'd bring a coworker along as a witness. That only happened on a couple of occasions. For the vast majority of patients, I'd just carry on and do my job, and not worry about it. Personally, I never worry about losing my license as long as I do my job conscientiously and according to best practice.

[Davey Do]

KMULL002 said:

I had the misfortune of taking care of a patient last weekend. ...I administered 1mg dilaudid...

The MD that same day increased the dilaudid dosage from 1mg to 1.5mg but the day shift rn told me in bedside handover report that the patient did not want 1.5 mg she only...wanted 1mg.

I asked her if she wanted 1mg or 1.5mg and she said she only wanted 1mg. I gave 1mg dilaudid and then flushed her. ...this patient stated after I gave her the 1mg dilaudid that she didn't feel it.

I offered the extra 0.5 mg (which would be 1/2 of the 1mg syringe) and she agreed to take it; I gave it to her.

After... this the patient calls my charge nurse to tell her she can't believe I did this to her: accusing me of not giving it to her (I guess). After I left the room I wasted the 0.5 mg left in the syringe.

My question is, how do I prevent someone from accusing me of not giving them their medicine?

My thought is that I tell them when I give it to them that I am giving them the 1mg of dilaudid right now. Do I always bring a witness?

Any suggestions?

Sour Lemon said:

when you're dealing with someone dramatic and accusatory, always bring a witness along. Every time.

Like I said before: This scenario is interesting yet confusing, so I'm going to try and break it down so it makes more sense to me.

Thank you for your patience.

[Davey Do]

KMULL002 said:

this patient stated after I gave her the 1mg dilaudid that she didn't feel it. I offered the extra 0.5 mg (which would be 1/2 of the 1mg syringe) and she agreed to take it; I gave it to her.

After I left the room I wasted the 0.5 mg left in the syringe.

I don't remember if I've ever given dilaudid, basically being out of medical nursing for over 20 years, so please bear with me here.

Since my medical nurse wife Belinda could easily answer this question for me, but is currently sleeping, a little search informed me that Dilaudid typically comes in 1mg/ml syringes.

Two 1mg syringes were used, right? A 1mg dose was administered, and then a second was used for the 0.5mg dose, correct?

Both doses were signed out (I'm assuming here) of the pyxis and a witness was used in order to waste the remaining 0.5mg used for the second dose.

Also- if a patient refuses the ordered dose of a medication to be administered, wouldn't it be an appropriate act to get a specific order for the 1mg dose?

Especially with a controlled substance?

[applewhitern, BSN, RN]

The dilaudid we use at my current hospital comes 2mg/ml in one syringe. Just saying.

[applewhitern, BSN, RN]

Over my 30 year career, I have had patients try to say they didn't think they received the full and correct dose because they "didn't feel it." If they don't feel that instant "high," they think they have been cheated. Patients will request that we push it faster, rather than slow, and complain that when so-and-so gave it, it felt different, so we must not have given it correctly. One hospital told us to give narcotics as slow as possible, because we had so many patients who probably didn't need it, but wanted to feel high.

[Davey Do]

The dilaudid we use at my current hospital comes 2mg/ml in one syringe. Just saying.

Okay, thank you, applewhitern, for that information.

Let's say, for lack of ------------- here, one 2mg/ml syringe dose was used. 0.5ml was injected into the IV and a flush followed, that fell off of the bed which the husband pointed out, was used, totaling a dose of 1mg. Then, 0.25ml was injected making the dose 1.5mg.

Was the second dose followed by the same flush that fell off of the bed that the patient's husband pointed out?

Saline flushes come in 3ml doses, do they not? Is the entire 3ml required for a flush following a medication administration? I wish my medical wife Belinda was awake!

And, was the wasted dose witnessed?

Like I said before, "interesting scenario"!

[AceOfHearts<3]

Okay, thank you, applewhitern, for that information.

Let's say, for lack of ------------- here, one 2mg/ml syringe dose was used. 0.5ml was injected into the IV and a flush followed, that fell off of the bed which the husband pointed out, was used, totaling a dose of 1mg. Then, 0.25ml was injected making the dose 1.5mg.

Was the second dose followed by the same flush that fell off of the bed that the patient's husband pointed out?

Saline flushes come in 3ml doses, do they not? Is the entire 3ml required for a flush following a medication administration? I wish my medical wife Belinda was awake!

And, was the wasted dose witnessed?

Like I said before, "interesting scenario"!

We only stock 10ml flushes where I work. My old job had 10ml and 3ml flushes.

[FolksBtrippin, BSN, RN]

My thought is that if a patient doesn't want 1.5 mg Dilaudid as ordered and instead wants 1 mg, I need to ask the doc to change the order to 1 mg. Is the patient saying that you gave her 1 mg instead of 1.5 mg inappropriately in the first place? Because the way I see it, you did. Not that I think it is a huge deal or that you should lose your license or get sued, but you need to follow the order. There is a good chance the patient did not understand what you were offering when you said, "Do you want 1 mg or 1.5 mg?" She probably just figured less is better, and didn't realize the order had been changed for her benefit.

It's a good idea to not be assigned to people you know. They might expect special treatment, and you might really feel like you have to give it to them. Or you might be lax about some stuff because you know this person. Or one of a billion other hangups that come from human relationships. We don't do this on purpose or even consciously sometimes. Just avoid this situation whenever possible.