The other night, I bent over backwards caring for this frequent-flyer drug seeker, making doctor calls, making sure his NPO status was removed the instant his testing was complete, diverting lab personnel so his labs could be drawn immediately, etc., etc. Nice as could be. Never had him as a pt before, but have seen him around. I served compassion with a smile and had my game on. My other patients were awesome, it was probably the best night I've had in a long time.
So...next morning, the day nurse tells me the pt accused me of not giving him his prn percocet at 0600! States he thinks I pocketed them, but that he "didn't see me do it." Then he apparently spent the day telling dialysis staff and whoever else he encountered that I had stolen his percocet. He was also caught smoking in the bathroom, but he lied and said he wasn't.
Fast forward, I came back and was supposed to be his nurse again, but I refused and switched his room with nurse K for a different one. Unfortunately, Nurse K had an issue as well. He was holding his percocet in his fist and would not open it and take the pills. he told her he had already taken them. So she told him she did not see him take them, and to open his hand. He refused. Finally he opens his hand, and oila! Two percocet. So he took them.
So anyway, I've been an RN for a year (LPN for 5 years before that) and this has never happened to me. Not sure what I should do. Thoughts?
I have never been accused of this, but a coworker was and I was assigned to rooms next to hers. She instantly informed the charge nurse when the patient made the accusation, and the charge nurse questioned the patient who said she "had not seen her nurse all night" and never received her oxycodone. I was asked to witness.
Charge reminded the patient that we have an eMAR that requires the armband on the patient to be scanned in the room as well as the medication being given. Also, this patient had multiple antibiotics and other medications during the night scheduled and all documented by the primary nurse. So charge asks, "if you haven't seen your nurse, then did you not receive your antibiotics this shift?" Patient is taken aback, "oh well yeah, but not the oxycodone, she ignored me". Charge then reviews the times of meds given, amounting to about 5-6 times the RN was in the room so far that shift. She then asked, "so are you still going to tell me that you haven't seen your nurse all night?". Patient begrudgingly admitted maybe she had and didn't remember, but adamant that she didn't receive the oxycodone.
Charge ended up basically saying that if the patient was claiming she hadn't seen her nurse, who was obviously in the room all night, then perhaps she just didn't remember getting the oxycodone either. From that point on, charge nurse gave the narcotics and I witnessed in the comment section. She refused to call the doctor for another dose.
Primary RN was really upset and filled out an incident report, e-mailed our manager, and volunteered for a drug test. Manager declined testing because this patient had well documented manipulative behaviors. Day shift had to call security on the patient after she tried injecting crushed Benadryl into her IV. That her mom brought her.
I had one of these patients years ago. The solution is easy.
Every time the patient has to take medication, two nurses or one nurse and another staff member stand there and witness the patient ingest the medication. If the patient refuses to comply, tell the patient that the doctor would discontinue the medication if there were any compliance issues. This also allows you to have an excuse in the event that you are late to getting this patient his or her meds as you can claim that there wasn't a second staff member available.
This might work as a deterrent for subsequent visits by drug seekers.
Having ONE of these patients YEARS ago.. does not qualify as an expert response.
OP did not see this coming. OP did not know the drug seeker was going to blindside them. You are saying every time ANY patient needs to take a narc, a witness must be present.
Set limits. Don't bend over backwards for drug seekers. Don't divert personnel for these people. They suck the system dry. Watch your patients take their pills ( if you didn't). I agree, there should be an alert by his name that 2 nurses witness his narcotic ingestion.
Set limits. Don't bend over backwards for drug seekers. Don't divert personnel for these people. They suck the system dry. Watch your patients take their pills ( if you didn't). I agree, there should be an alert by his name that 2 nurses witness his narcotic ingestion.
"Drug seekers" are no different than any other patient. Again: I need to watch you take your meds.
i'm a little confused by all the people here advising OP to make sure she watches the patient take the meds every time. I mean, don't you all do that with all your meds on all your patients anyway? Personally, I doubled back earlier this week because my patient didn't want his Tums until after he finished his meal, and I brought it when I saw him with his tray. I can't imagine OP is in this situation because she was handing out narcotics, and saying, "here, take this and i'll see you later." How would watching your patient take his/her meds protect you against a lying patient?
Now you know that being "Nice as could be." Is not the way to handle drug seekers.
Being nice is viewed as a sign of weakness. You need to be firm and set clear limits.
Tell me you reported this to supervision!
This is some of the best advice. The more special dispensations you make for unreasonable patients, the more unreasonable they will be. I have found they have much more respect for staff who are fair and firm with them.
i'm a little confused by all the people here advising OP to make sure she watches the patient take the meds every time. I mean, don't you all do that with all your meds on all your patients anyway?
Nope. I watch narcs like a hawk, but not all the others.
Specializes in orthopedic/trauma, Informatics, diabetes.
I watch all meds. I have heard too many stories of nurses getting fired for leaving meds in the room for pt to "take later". If the person tells me they need to take with food, I offer to bring something like crackers. If not I return it, notify doc and pull another dose later if I have to.
Specializes in UR/PA, Hematology/Oncology, Med Surg, Psych.
In the case of the OP, I personally would ask to not be assigned to that patient again. I don't abide patients lying and messing with my livelihood. Don't stress about it though, a drug screen would clear you anyway.
As for leaving meds at the bedside, I don't do it. If a patient says they want such and such pill in an hour or whatever, I tell them that I am not allowed to leave it with them and to call me when/if they want it because I probably will not remember to return with it later. Then I replace the med in the pyxis, chart it, and if need be notify the Dr. That way it's over and done with unless the patient calls. But if it is an important med, I educate the patient further and I'll write myself a note so I will re-offer it again later.
Karou
700 Posts
I have never been accused of this, but a coworker was and I was assigned to rooms next to hers. She instantly informed the charge nurse when the patient made the accusation, and the charge nurse questioned the patient who said she "had not seen her nurse all night" and never received her oxycodone. I was asked to witness.
Charge reminded the patient that we have an eMAR that requires the armband on the patient to be scanned in the room as well as the medication being given. Also, this patient had multiple antibiotics and other medications during the night scheduled and all documented by the primary nurse. So charge asks, "if you haven't seen your nurse, then did you not receive your antibiotics this shift?" Patient is taken aback, "oh well yeah, but not the oxycodone, she ignored me". Charge then reviews the times of meds given, amounting to about 5-6 times the RN was in the room so far that shift. She then asked, "so are you still going to tell me that you haven't seen your nurse all night?". Patient begrudgingly admitted maybe she had and didn't remember, but adamant that she didn't receive the oxycodone.
Charge ended up basically saying that if the patient was claiming she hadn't seen her nurse, who was obviously in the room all night, then perhaps she just didn't remember getting the oxycodone either. From that point on, charge nurse gave the narcotics and I witnessed in the comment section. She refused to call the doctor for another dose.
Primary RN was really upset and filled out an incident report, e-mailed our manager, and volunteered for a drug test. Manager declined testing because this patient had well documented manipulative behaviors. Day shift had to call security on the patient after she tried injecting crushed Benadryl into her IV. That her mom brought her.