addicted patients

you can't withhold if they're in pain. you can try something else, but you can't withhold.

What kind of a facility do you work in that the pts recieve "tons of dilaudid"? I have always been taught that a pt. can not get addicted from only several days of use and if taken appropriately. However, I really don't know if that is true.

I would think that maybe slowly weaning the dilaudid dose would help to prevent withdrawal, if that is what the pts are experiencing.

Also, as is reminded to us, pain is what the pt says it is.

We have a pain management team that we call to help deal with patients on large doses of pain meds. It's sad. The current thinking of subjective pain needs to have some checks and balances, to not fall into the "creating addicts" category, that is a fine line. That's where our pain team comes in.There are many new ways to control pain that are non narcotic.

Our hospital docs prescribe dilaudid quite often.

I work on a med surg unit.

Every once in a while we get a return "customer" in a few days.

They have mysterious pains and want more dilaudid.

I am a fairly new nurse.

So I don't know if they are addicted or just want more.

We are looking at someone with negative tests. Good vital signs. Good labs.

Like the one today. She was clutching her upper abdominal area. Seemed to be in real pain. At least to me.

But some of the more seasoned nurses say she is playing games.

Maybe she is.

Or maybe she is addicted.

I don't know. I am told to give diluted dilaudid by the other nurses.

The doc comes in and says give her 1mg q 3hr.

If I do what the doc says, the nurses will be mad at me because I'm not backing them up.

If the girl is playing games, then I suppose they are right.

IF she is addicted, then maybe the doc is prolonging the problem.

I keep seeing this sort of problem.

It's bugging me big time.

I am told to give diluted dilaudid by the other nurses.

The doc comes in and says give her 1mg q 3hr.

You CANNOT alter the doctors order. The drug has to be administered as ordered. The other nurses are prescribing without a license if they are not giving the full dose ordered.

and if other nurses do not medicate thinking the pain isn't real, they are practising medicine without a license. think of it fro the pt's point of vierw: i had surgery 5 days ago and had a rough post-op period because of pain. if my pacu nurse, who knows i had a chemical dependency history, did not medicate because she thought i was addicted, would that have been fair?

How dare those nurses for determining if someone is in pain or not. And that doesn't even cover the fact that they are altering a dr order and practising medicine without a license. What one may perceive as pain may be nothing to me...but I am not the pt!! I once had someone tell me I was not in pain...during 36 hours of labor followed by c section...the dr happened to be right behind the nurse when she said it...big mistake for her. On the other hand I just had a total hip replacement in July and the nurses could not get over the fact that all I wanted was a tylenol...the pain after sx was nothing compared to what I had been living with prior.

And the nurses will be mad at you? As a prudent nurse and advocate for your pt what do you think you should do? Medicate when someone states they are in pain or join the crowd and presume the pt is fibbing? I am not trying to be rude with what I just said, but this is serious. PAin management team need to be consulted for the pt's.

The nurses were giving the lowest prescribed dose in the prescribed range.

So, what they were doing was fooling the patient into thinking she was getting a higher dose.

Except it didn't work for me.

I may sound like a moron to you.

But, I'm really in a quandry.

I don't want to alienate the other nurses. They aren't happy when they take over and have to give pain med right on the minute, hour after hour.

Some of our patients have even set their watches to alarm when their meds are due!

Is it EVER right to tell a patient no when they ask for pain med when it is due?

And what if you think they are addicted? (they deserve compassion too)

I like the idea of a hospital having a pain management committee.

Being a new nurse is hard.

I want to learn. Teach me. (and thank you for your answers- I think you guys are awesome)

you're not being a moron, you're trying to learn.

if addictive behavior is truly a concern, the docs need to be informed of the concerns and the pt evaluated for pain management options.

the pt has a right to pain relief. if other nurses are only giving the minimum and pts are not getting relief, that is poor nursing and those rns can even be reported to the bon. if they get mad at you, tuff chit, you're doing what you're supposed to do.

Don't feel bad. We've ALL had patients that we knew were drug seeking. But that said, it's not up to me to correct that behavior if the doctor has chosen to not recognize it. I will call in pain management, I will call the social worker, but other than that I follow the orders.

I'm only a student, but isn't it appropriate to bring the patient into this conversation? "Many people who use these types of pain relievers find they have a difficult time stopping the medications," etc. Speaking frankly about it may encourage the patient to talk about addiction vs. pain issues. If the patient is in denial, perhaps it woud help to gentily remind them that they probably will not be able to ensure an inexpensive supply of pharmaceutical grade narcotics once they leave the hospital. So, wouldn't it be better to address those issues rather now than later...

I'm only a student, but isn't it appropriate to bring the patient into this conversation? "Many people who use these types of pain relievers find they have a difficult time stopping the medications," etc. Speaking frankly about it may encourage the patient to talk about addiction vs. pain issues.

yes, the pt should be brought into it, but not like that. if pain is the issue they are not going to want to talk about addiction.