These pts are on tons of dilaudid....then no wonder several days later they come back sweating, crying, with mysterious abdominal pain. The only thing that works is more dilaudid.
Are these pts addicted? Or are they faking?
How to know?
If we got them addicted, don't we have the responsibility to UN addict them?
Is the best way to withold pain med? Or wean them down? Give them diluted pain med?
What to do???
This seems to be a real problem at our hospital.
These pts drive me crazzzeeee!!!
All they do is beg for pain med.
Help me know.
Other nurses want to withold.
But I'm left with the whining, begging, crying all day. (theirs and mine!)
And the dr. deals with it by prescribing the desired pain med. Help!
We have a pt on the floor right now that c/o ab. pain rated 9/10 and unrelieved by any pain med we have given up to this pt, which includes Dilaudid q1hr, pt had an epidural for 2 days and he said that it didnt work, morphine iv, Lortab elixer, and the list goes on and on. This pth has had numerous tests that have all come back negative and frankly Im at the point where SOMEONE needs to get this pt out of the hospital and into rehab somewhere IMO. I asked the pt the other night if the Dilaudid iv helps and he said no not at all so my next question was" if it doesnt help then why do you want it?". He just looked at me and said "so you think im a seeker too". I didnt say it but thats exactly what I and every other nurse on the floor feels. Im going to talk to the Manager and see what can be done about this cause this has been going on for 3 weeks and frankly we are just feeding into this guys addiction. In this case we are the "enabler" and that is just not right.
Have they done a porphyria workup?
My first husband was diagnosed with porphria. His mother had had it for 20 years but it took him 3 years of pain before a doctor actually took a history from him and had him tested. (He was the type that thought doctors could read your mind) Porphria can also be aquired during a lifetime.
He had long hair and rode a motorcycle.
During an attack, he would complain of severe abdominal pain that wasnt relieved.
I watched him be labeled a drug seeker for years. The nurses didnt bother to educate themselves about his disease, even when I brought them tons of info. It took him almost dying during an attack after 5 years of suffering before the hospital educated the staff on how to treat him. He would be inpatient for 3 months at a time sometimes.
I watched nurses give him diluted pain meds too. How do I know? thank God for one nurse who believed him that he was in pain.
He suffered for years being labeled as a drug seeker. I couldnt tell you the times he cried because an attack started during the hours his doctor wasnt in the office and he had to go to the er. He was treated like he was nothing.
He died a year ago.
So the next time you think someone is drug seeking...maybe you could remember what Ron went through.
I'm concerned about nurses giving diluted meds. That's just wrong. Who are they to judge if the person is in pain or not? If the doctor prescribes it, give it to them. A nurse does not have the right to withhold pain med. I'm wondering what happens to the extra pain med that is removed to dilute it? If I were you I wouldn't do it.
Southern: I am truely sorry for you with regards to losing your husband. I meant no disrepect to you personally and my comments were not directed to you or your family. Again I am sorry for your loss..
Specializes in PICU, Nurse Educator, Clinical Research.
On the way home I got to thinking about my pt.
These pts are on tons of dilaudid....then no wonder several days later they come back sweating, crying, with mysterious abdominal pain. The only thing that works is more dilaudid.
Are these pts addicted? Or are they faking?
How to know?
you left out the third possibility- are they in pain??
if a patient says they're in pain, we have to believe them. if they have orders for pain meds, give them. it's not the job of the nurse to decide whether they're 'really' in pain.
If we got them addicted, don't we have the responsibility to UN addict them?
even if this *is* the case (and I don't think there's any evidence in your post suggesting that it is), it's not the nurse's responsibility. if there is a genuine concern that a lengthy hospitalization has created a chemical dependency, then a pain management team (or pain management doc) needs to get involved.
Is the best way to withold pain med? Or wean them down? Give them diluted pain med?
no....no...and absolutely NOT! if i were a patient and my nurse was doing any of the above, i would be making complaints up the chain of command until I was heard. all of the above, without a physician order, are malpractice. if other nurses are doing these things, they're guilty of malpractice.
one thing that would help everyone involved is proper charting, including accurate assessment before giving *and* reassessment after giving pain meds. for example, if the order is for 1-3 mg dilaudid iv q 3 hrs prn, get a pain scale rating before giving the med; reassess 30 minutes later, and document both. that way, the physician will see if the dosing schedule needs to be adjusted, or a different med given, etc. if someone is getting the maximum prn dose all day long and their pain level is not decreasing, something needs to be adjusted.
some places require the physician order to specify which dose to be used for what pain rating: 1 mg for pain 1-3 out of 10; 2 mg for 4-6 out of 10; 3 mg for 7-10 out of 10. or they'll use mild/moderate/severe. when this is combined with charting the effectiveness of the dose given, it can help a LOT.
i've read articles about how scheduled pain meds are far more effective than simply writing for PRN's...once your pain is 10/10, it can take hours of maxing out your PRN dose to get it back down, when it would've been better to have a set schedule in the first place. this has been my experience as a patient, as well.
What to do???
This seems to be a real problem at our hospital.
These pts drive me crazzzeeee!!!
All they do is beg for pain med.
Help me know.
Other nurses want to withold.
But I'm left with the whining, begging, crying all day. (theirs and mine!)
And the dr. deals with it by prescribing the desired pain med. Help!
Getting a pain management specialist to do an inservice on pain would probably be very valuable. as someone who's been on the patient side of this issue, it pains me (no pun intended!) to hear about things like this.
Specializes in Education, Acute, Med/Surg, Tele, etc.
Patients are not allowed to leave our floor until they are on a po pain medication prescribed by the MD (of course there are exceptions dependant). They are also monitored for how many they have in a given time period and can be held till they can achieve pain control within an MD's prescribed home tx...if they can't then they are re-evaluated and we try again till they meet that criteria and can go home.
This helps with some of your 'drug seekers' because they don't like going through all that...but it is very benificial in getting the right tx for home that a person needs once home! If pain management isn't working in the hospital...there are underlying factors to consider and fix before sending them home...
The down side...longer stays in hospital, and some not covered by insurance!!! We try really hard as RN's with our MD's to get that pain management done as quickly as possible in our pts best interest and health so that we avoid the insurance complications.
So far so great actually :)! I find it really helps to get the pt involved proactively and really explain and follow goals for pain management! Using non pharm ways is helpful too..and I have a very extensive bag of tricks of those :), and those cost a heck of a lot less for sure...LOL!
And like others have said...I can not label my pt as 'drug seeker' or 'faking'...I can not judge that, but can judge what they say and try to fix that to the best of my ability and with communication with my team!
I am also a new nurse, and when a resident told me "just give her some benadryl and tell her it's morphine" to a patient in pain, I told her that's unethical. Some of the other nurses have told me to dilute things, but I put down my foot and said NO. Providers start lying when they don't know how to confront the situation. It screws up the MD when they think the patient has had all this medication, when in reality nurses were diluting it! In your situation it sounds like patients are physically dependent, then going into withdrawal. It helps to titrate doses down to "wean", this is in partnership with the MD. Also to keep them on a schedule. Patients need pain management follow up outside the hospital. You can't send them home on percocet & dilauded & say, have a nice day! Non-pharm methods should be explored as well. Patients need to have a plan & a goal.
I've had a few patients that required massive amounts of meds because of past chemical dependency. Also patients who everyone said was "drug seeking", but they were in pain, and when the pain subsided so did their need.
It's good that you're bothered by this. Do what you know is right and look at the literature, don't just follow what the other nurses do. As new grads, we have to be conscious of how we shape our practice.
I am also a new nurse, and when a resident told me "just give her some benadryl and tell her it's morphine" to a patient in pain, I told her that's unethical. Some of the other nurses have told me to dilute things, but I put down my foot and said NO. Providers start lying when they don't know how to confront the situation. It screws up the MD when they think the patient has had all this medication, when in reality nurses were diluting it! In your situation it sounds like patients are physically dependent, then going into withdrawal. It helps to titrate doses down to "wean", this is in partnership with the MD. Also to keep them on a schedule. Patients need pain management follow up outside the hospital. You can't send them home on percocet & dilauded & say, have a nice day! Non-pharm methods should be explored as well. Patients need to have a plan & a goal.
I've had a few patients that required massive amounts of meds because of past chemical dependency. Also patients who everyone said was "drug seeking", but they were in pain, and when the pain subsided so did their need.
It's good that you're bothered by this. Do what you know is right and look at the literature, don't just follow what the other nurses do. As new grads, we have to be conscious of how we shape our practice.
you're in a burn unit?? i sincerely hope the resident that told you that wasn't talking about a burn pt!!!
Isn't abdominal pain a s/e of withdrawl?? I think that it is important to note that many (if not all) of these patients are in a dependancy situation by no fault of their own.
Isn't abdominal pain a s/e of withdrawl?? I think that it is important to note that many (if not all) of these patients are in a dependancy situation by no fault of their own.
T
Yes. Many of these patients have iatrogenic dependence, not addiction.
I hate it when a doctor orders dilaudid 2mg iv q2h prn...everyine I have ever given dilaudid to is begging for it again before the two hours are up and if more than one person gets it that frequently I think we might as well start drips on them...one nurse just can't keep up.
One question I have when you talk about diluting meds, I dilute everything I give especially dilaudid because it is so harmful to veins that when diluted
the iv's last longer. Why shouldn't I dilute meds? Another thing, if the meds are diluted the patient doesn't get the inital rush when given undiluted.
I'd have to agree with this - I know when I was recently in the hospital, it seemed as if some of the nurses thought I was a pest for asking for pain meds when they were due. Yes, my pain was more or less under control at times, but unfortunately experience has taught me that when you're in bad pain, once it's under control, keep taking the pain meds - it's much easier to KEEP under control. As one doc told me "take the pain meds, even when it doesn't hurt - at least for a couple days".
I did have one nice nurse who understood my predicament, and even wrote on a little whiteboard when my next dose was due "Morphine, 9:00PM, Percocet, 11PM". That being said, it seems on floors these days the staff is too shorthanded to follow up (coming in 30 minutes later to reassess pain levels).
My plan is to just medicate as ordered. Being a patient in pain, I wouldn't want to subject anyone to the tortures of undermedicated pain.
But yes, I admit I was strongly insisting on pain meds, requesting them when they were due, and even becoming anxious if they were running late. Then again, I had second / third degree burns on my arm, and was awaiting skin graft surgery the next morning.
I hate it when a doctor orders dilaudid 2mg iv q2h prn...everyine I have ever given dilaudid to is begging for it again before the two hours are up and if more than one person gets it that frequently I think we might as well start drips on them...one nurse just can't keep up.
One question I have when you talk about diluting meds, I dilute everything I give especially dilaudid because it is so harmful to veins that when diluted
the iv's last longer. Why shouldn't I dilute meds? Another thing, if the meds are diluted the patient doesn't get the inital rush when given undiluted.
i believe in this case the dilution is to give the appearance of giving more. i dilute ivp meds too, but not to fool the pt
southern_rn_brat
215 Posts
Have they done a porphyria workup?
My first husband was diagnosed with porphria. His mother had had it for 20 years but it took him 3 years of pain before a doctor actually took a history from him and had him tested. (He was the type that thought doctors could read your mind) Porphria can also be aquired during a lifetime.
He had long hair and rode a motorcycle.
During an attack, he would complain of severe abdominal pain that wasnt relieved.
I watched him be labeled a drug seeker for years. The nurses didnt bother to educate themselves about his disease, even when I brought them tons of info. It took him almost dying during an attack after 5 years of suffering before the hospital educated the staff on how to treat him. He would be inpatient for 3 months at a time sometimes.
I watched nurses give him diluted pain meds too. How do I know? thank God for one nurse who believed him that he was in pain.
He suffered for years being labeled as a drug seeker. I couldnt tell you the times he cried because an attack started during the hours his doctor wasnt in the office and he had to go to the er. He was treated like he was nothing.
He died a year ago.
So the next time you think someone is drug seeking...maybe you could remember what Ron went through.