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Accused of not giving dilaudid

Nurses   (9,519 Views 74 Comments)
by KMULL002 KMULL002 (Member)

KMULL002 specializes in Ortho, Neuro, Surgical, Renal, Oncology.

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You are reading page 2 of Accused of not giving dilaudid. If you want to start from the beginning Go to First Page.

Been there,done that has 33 years experience as a ASN, RN.

4 Followers; 68,882 Visitors; 6,203 Posts

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.

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angiebelle440 has 7 years experience and specializes in Ortho, peds.

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CHILL. Just chill out.

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

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10,390 Visitors; 1,381 Posts

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.

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JBMmom has 6 years experience as a MSN and specializes in Long term care; med-surg; critical care.

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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.

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not.done.yet has 8 years experience as a MSN, RN and specializes in Critical Care; Cardiac; Professional Development.

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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.

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SilleLu has 3 years experience.

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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.

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6,426 Visitors; 526 Posts

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.

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Tenebrae has 6 years experience as a BSN, RN and specializes in Primary Health, Gerontology, Palliative.

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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

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2,043 Visitors; 189 Posts

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.

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9 Followers; 23,235 Visitors; 3,097 Posts

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:

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Kallie3006 has 7 years experience as a ADN and specializes in Surgical, Home Infusions, HVU, PCU, Neuro.

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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.

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KMULL002 specializes in Ortho, Neuro, Surgical, Renal, Oncology.

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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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