Few days ago, one of the nurses held Dilaudid from patient until she (the nurse) sees the person who will drive this patient home because patient drove herself to our ER. Patient did not have any problems with it and was willing to wait, however, our manager told her to give Dilaudid now and that she is not suppose to hold the pain medicine or any treatment just to see the responsible driver physically.
That separated our nurses in two groups here:
Group 1: "I will not give this patient Dilaudid until I see the driver because I do not want to put my license at risk when this person elopes after Dilaudid and runs over a bus full of nunns. I do not want to go to court and have it on me for the rest of my life that I contributed to killing of innocent people. My preceptor told me when I was a young nurse to always wait until I can see reponsible driver in person because many patients will lie to you that someone is coming but what truly ends up happening is that they get discharged and drive off in their own car!"
Group 2: "You cannot hold Dilaudid from patient who told you that someone is coming to get them. You have to exercise a certain element of trust to what patient tells you. It is the same with drinking and driving, police officer exercises a certain element of trust that when you go to the bar, you won't get illegally drunk and can drive yourself home. If patient told you ride is coming, you can give it to them. All you can do to be a prudent nurse is to WARN this patient that she/he cannot drive home, that medicine inhibits your reaction, and DOCUMENT that you told them. Also document that patient verbalized understanding and has made arrangements for someone to come and get him/her. That is it. It is wrong to hold the medicine just because you don't trust this person and want to see the driver physically. And then how far do you go? The person may come to the room but they can still drive in separate cars (pissed at you and complaining to your manager the next day because they told you ride is coming but you have trust issues). To insure that they don't run over the bus full of nunns you either have to give it to them at their house and stay with them for 4 hrs or at the ER and then make them lay in bed for four hrs. Seeing someone in the room who says they gonna drive them does not mean your patient will not get in her car on the parking lot. And are you going to the parking lot too to make sure they get in one car?!!"
Is there any policy that can back one or another point of view state wide? I work for HCA and there is no specific policy for that.
Specializes in NICU, PICU, Transport, L&D, Hospice.
It is difficult to imagine the lack of compassion that is required to let a patient seeking pain relief in your ED to continue to suffer because of a tangentially related social issue (needing a driver/ride).
Not having a driver or a ride, in my view, does not mean that we don't provide proper treatment. Rather, it means that we don't discharge into an unsafe circumstance after we have provided the appropriate care.
It is difficult to imagine the lack of compassion that is required to let a patient seeking pain relief in your ED to continue to suffer because of a tangentially related social issue (needing a driver/ride).
Not having a driver or a ride, in my view, does not mean that we don't provide proper treatment. Rather, it means that we don't discharge into an unsafe circumstance after we have provided the appropriate care.
The problem is where do you plan on holding these patients? I work in a small ER, we don't have room for patients to 'recover' from pain medications and also lack the staff to monitor for this length of time. If a patient doesn't have a ride they are often given a script to take to their pharmacy. The only time a doc decided to deviate from this plan ended in a huge disaster that caused a huge headache for the entire staff including registration and security.
I am obligated to educate the patient about the requirements of having a designated driver if they are going to receive certain medications.
I educate.
I medicate.
I document.
I discharge when the provider determines that discharge is appropriate.
If no driver is available the patient may travel by bus or taxi presuming they are able to get to the bus stop (right outside the hospital grounds) or have the finances.
It seems to me that the need for the pain medication is a separate topic from discharge and I would not intend to cause a painful patient to suffer in the ED because they do not currently have someone in the unit to drive them. They are there needing care and treatment.
Fully agree here and is my current practice. A bartender can give out ETOH but he isn't required to make sure the guy has a ride. Its the drinkers responsibility to not drive EVERYONE knows that. Now its our job to make sure the PT KNOWs that after this medication, if he is caught driving it is a DUI.
I was a single mother when I went to have my tubes tied before my soon-to-be-ex husband's insurance no longer covered me. Needless to say, he wasn't driving me to and from the day surgery unit-- I didn't even tell him I was going. (This made for a very interesting conversation he had with my soon-to-be new husband about four years later-- he asked if we planned to have more children...hehehehe .... boy-o-boy was he pissed off to learn something about me he didn't know but my true love did ... control freak to the bitter end, but I digress...). I had zero sedation by my own request and a spinal, so when it wore off and I was ready to go, I was ready to go. They wouldn't let me leave to drive myself, and didn't really care that I had had zero mind-altering medication.
So I called a friend of mine who worked in one of the offices there. She came down to get me, and she drove my car around the corner, parked it, and walked back to her job. I drove to daycare and picked up my kids. :)
So when can a HCP prevent a pt from leaving AMA? Any pt can leave when they want otherwise its a violation of civil rights.
Specializes in NICU, PICU, Transport, L&D, Hospice.
The problem is where do you plan on holding these patients? I work in a small ER, we don't have room for patients to 'recover' from pain medications and also lack the staff to monitor for this length of time. If a patient doesn't have a ride they are often given a script to take to their pharmacy. The only time a doc decided to deviate from this plan ended in a huge disaster that caused a huge headache for the entire staff including registration and security.
That is a good question.
It is not mine to answer. That question and answer is owned by the facility which is sponsoring the medical care. The facility that said to the community that they could come to their ED for emergency care. The need for pain relief can certainly be emergent, especially to the poor soul experiencing an acute exacerbation.
In my experience the answer to your question is driven largely by $$ which (along with satisfaction scores) are more important to many hospitals than patient outcomes.
I'm in Canada. We let the patient know they will need a ride after the sedating med, we may even try the nonsedating stuff first. If they need a sedating medication, and want it despite not having a drive, we give it. Then expect them to come up with a way home, bus, taxi, friend. If I see an impaired person getting into a car to drive home, I call the police and inform them. I'll also let the patient know I am obligated to call police if they do try to drive home. We can't force people to stay (kidnapping) and we can't withhold needed meds.
I'm in Canada. We let the patient know they will need a ride after the sedating med, we may even try the nonsedating stuff first. If they need a sedating medication, and want it despite not having a drive, we give it. Then expect them to come up with a way home, bus, taxi, friend. If I see an impaired person getting into a car to drive home, I call the police and inform them. I'll also let the patient know I am obligated to call police if they do try to drive home. We can't force people to stay (kidnapping) and we can't withhold needed meds.
It is difficult to imagine the lack of compassion that is required to let a patient seeking pain relief in your ED to continue to suffer because of a tangentially related social issue (needing a driver/ride).
Not having a driver or a ride, in my view, does not mean that we don't provide proper treatment. Rather, it means that we don't discharge into an unsafe circumstance after we have provided the appropriate care.
I have worked in ER for a lot of my career and although it was a small town our policy was if the person drove themselves to ER and they wanted pain medication or any medication that could alter their driving they would have to either wait till driver arrived, hand over their car keys or take meds in pill form with them if they are ready to leave now and take when they got home.
I would give it and document that client has a ride and that client fully understands that driving is off limits. You gotta go on with your day and if the person is fully coherent and able to make decisions you have to trust their word and not treat them like a child.
We give it, educate while "sober" and tell them that they need to get a ride. If they have to hang out in the lobby for 3 hours, so be it. If we see them get into a car, we call the cops for driving under the influence of narcotics (state cops will make them test).
At my old job we weren;t allowed to call the cops but we call them all the time here.
My understanding is that you cannot withhold medication that is physically safe for the patient to take and is ordered by the physician. And you cannot hold the patient there against their will after giving said medication if they don't have a ride (that's called false imprisonment and I don't feel like going to jail anytime soon). But, if I feel that the patient is going to be unsafe in the car I immediately call the police on that patient's departure from the ED (the police aren't far from us and we always have an officer stationed in the hospital). They can then do a sobriety test and take it from there.
Of course I also document the hell out of the entire encounter.
toomuchbaloney
16,058 Posts
It is difficult to imagine the lack of compassion that is required to let a patient seeking pain relief in your ED to continue to suffer because of a tangentially related social issue (needing a driver/ride).
Not having a driver or a ride, in my view, does not mean that we don't provide proper treatment. Rather, it means that we don't discharge into an unsafe circumstance after we have provided the appropriate care.