Accused of not giving dilaudid

Nurses General Nursing

Published

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.

Research borderline personality disorder. You will come across them occasionally. They can bring down the strongest nurse.

Do not let them win. Now you know...if you even get a hint of borderline... bring a witness.

Specializes in Ortho, peds.

CHILL. Just chill out.

You can't fix crazy, but you can document the hell out of it.

She already has a reputation for being crazy at your hospital, so I think you're OK for the dilaudid. But a witness is not a bad idea if she's in the habit of fabricating stories.

Specializes in New Critical care NP, Critical care, Med-surg, LTC.
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.

I know where I work we often have multiple PRN orders based on pain scale. I may have a 0.5, 1.0 and 1.5 dilaudid available, so it would be appropriate to administer any of them. However, if 1.0 mg was administered, the 0.5 would not be available until the appropriate time interval had passed. We're unable to just add the additional medication after administration. But, that's beside the point here.

Sorry you had such a tough time with this patient. I think we've all been there and you'll be fine, complaints from a chronic complainer are usually identified as such.

Specializes in Critical Care; Cardiac; Professional Development.

Generally speaking, with no evidence of diversion, the patient will not really have a leg to stand on. If you followed orders, documented appropriately and continued good care and this patient has a documented history of complaints, escalating behavior and manipulation, you have nothing to worry about.

I'm wondering if you pushed the medication slowly, which of course is correct, while other nurses had been pushing it faster, giving her the quick buzz. Might explain why she is accusing you of not giving it.

I give Dilaudid frequently at my job. Usually there is ranges for the dilaudid depending on pain level , for example give 0.5 mg for pain 1-5 and then give 1mg for 6-10. In your case , I would have called for a witness to every time , pain medication was administered and document it.

Specializes in Mental Health, Gerontology, Palliative.

Document, document, document

And any wastage do it straight away with a witness and get the witness to countersign what was wasted.

This person does sound like they have some marked axis 2 issues

I know where I work we often have multiple PRN orders based on pain scale. I may have a 0.5, 1.0 and 1.5 dilaudid available, so it would be appropriate to administer any of them. However, if 1.0 mg was administered, the 0.5 would not be available until the appropriate time interval had passed. We're unable to just add the additional medication after administration. But, that's beside the point here.

Sorry you had such a tough time with this patient. I think we've all been there and you'll be fine, complaints from a chronic complainer are usually identified as such.

My hospital has the same policy. I know one reader was confused about the dosing - my docs frequently put in multiple orders for the same medication with different doses depending on severity of symptom.

Also, my hospital policy is that a nurse can administer a lower dose of pain medication than ordered based on pt preference and nursing judgement.

My hospital only has 10ml syringes, and when I don't flush the whole amount sometimes pt's ask if I have not given the whole "dose." I have to explain it's just a flush, but I'm sure they don't all believe me.

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.

You don't.

This tale includes entirely too much drama; RNs are not required to participate in that.

A couple of general practical tips:

- Waste at the time med is removed from dispensing machine.

- Inform patients what you are giving and how much when you arrive to the room and also while pushing the med. Assure them that you hope the medication will help make them more comfortable in the next _____ mins. [appropriate time frame]. Let them know that it isn't expected to make the pain go away completely. Also let them know that it won't knock them out or give them a head rush (or whatever you want to call it). Just be pleasant and conversational; let them see you care about their comfort. Let them know you will check on them again to make sure the pain is lessening/improving.

**

During an occasion when I was helping another nurse's patient several minutes after she had administered pain medication, the patient told me "whatever that other nurse did, didn't help the pain at all." I asked for clarification of whether the patient was saying the med wasn't given (because that's what the patient was implying), and the pt said, "I don't know, I mean I saw her put 'something' in, but it didn't do anything" (I'm paraphrasing, but there was no mistake that this was an accusation). For reasons I won't get into here, I didn't believe that for one single second, so I said, "Let me get your nurse so that we can get to the bottom of this. We want you to have pain relief." I left the room amidst the patient's sudden protesting and came back with my coworker and...we got to the bottom of it (pt recanted and apologized multiple times).

I don't play games, and that ^ is how I think it should be handled. Also, if I sense behavior like this I won't do anything without a witness and I usually inform someone (supervisor) in real time that there is an issue.

**

If you entertain drama, you will get more of it - and you inherently become part of it. Judging by your OP, it seems like maybe this is something worth consideration. Just deal pleasantly and fairly with the patient, address issues in real time, and get a witness as appropriate. Forget all this other drama.

:up:

Specializes in Surgical, Home Infusions, HVU, PCU, Neuro.

We deal with dilaudid a lot on my unit and depending on the day, and which way the wind blows, we have dose syringes as 0.5mg, 1mg, and 2mg per ml. We also only have prepackaged flushes in 10ml, although I have seen 3ml before, just not often.

The situation is hard to follow, and with a lot of unnecessary details IMO. My first question would be why did the doctor increase the order from 1mg to 1.5mg? Generally doses are not increased unless the patient is complaining the current treatment plan is not effective. If passed in report patient is only requesting 1mg vs 1.5mg, why not get an order for 1mg instead, although that negates the recently ordered increase that was done by the doc.

If nurses quit or changed employment status for every difficult patient, there would be none working. I dont understand why the previous nurses did this based on just this one lovely patient.

If the patient has a track record of unsatisfactory service, and you have outside experience of this firsthand, I dont understand why a witness wasn't used to begin with, that's just me though.

Specializes in Ortho, Neuro, Surgical, Renal, Oncology.

Yes I've been a nurse for 11 years and have been assaulted and battered. I just know this person and to know what kind of character she is and I know she's litigious I just allowed her to make me feel insecure. She's the type of person he scrutinize everything you do and it was just not a good experience. Not at all. I know I did the right thing I'm just afraid of being called into a lawsuit that has not happened to me yet.

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