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.
