I need a professionals help on showing me the right way to protect myself and my license. I am an lvn and I work at a nursing home. We have a 46 year old female that's a patient there. Her history states she was a heavy drug user and seeker before she was admitted into our facility. The problem is, the physician gives her whatever she wants. For example, some of her routine meds are dilaudid, soma, duragesic patches, tegretol, etc. Next she complained that she has a cough that robitussin want help. So he puts her on prn phenergan elixir(which is also an antihistamine), then she c/o itching due to her patches, he then puts her on prn benadryl. Two days ago she called the doctor's office herself and stated she had oral pain because the dentist saw her. The doctor's nurse called our facility and gave a t.o. for hydrocodone. The only problem there was, the dentist didn't do any oral procedure on her. And she had never complained of pain to us. The patient frequently comes to the nurses station asking for different meds: phenergan elixir, benadryl, combivent, etc. She just about wants every prn drug she has.
My question is: what do I do to protect myself and my license? she has orders for these meds and she makes the complaints. She also has a drug book in her room. She's very smart. I try to make the best judgement, but it's hard when the patient and the doctor agree on everything. When she complains of a problem, do I give her prn or refuse her? How do I deal with a very drug smart, drug seeker and be in the right with my Texas state? Please help me someone.
The reason they accepted her into our facility is because she didn't have anywhere else to go. She's been kicked out of other long term care facilities. She has no family. She was an orphan. She's her own primary contact. And as I stated before, it's just not painkillers she seek, she wants all meds. When she was admitted into our facility, everyone knew she was a drug abuser and it's documented.
My thing is, I just want to protect me and my license by doing the right thing. So I have been documenting everything. This is the first time I've encountered a person like her. I just want to be in the right. You know? Her physician is very much aware of her behavior. Uh, oh!!! Time for me to go to work. You guys keep replying. It's helping me more than you know. God bless ya'll for the help. Ro
What a sad story, there by the grace of G-d go we all,
I would give the drugs PRN after evaluating (according to her own words) what her complaint is, charting the complaint, the med given as per MD order and FOLLOW UP nurses note how the medication affected her- made her sleepy, reduced the pain or itching or whatever.
I would bring this up at the multidisciplinary meeting in front of the MD, SW, DON etc. Make sure all of the above is documented. Perhaps a team approach could be considered to wean her off some of the drugs if the MD agrees, and encourage greater independence. Perhaps if she was busy with recreation activities or a volunteer to take her out for a while, she would be less dependent on the drugs.
Make sure you have a clear careplan.
It sounds like you really care about her, which I am sure is worth more than the drugs, a human touch could make all the difference
The reason they accepted her into our facility is because she didn't have anywhere else to go. She's been kicked out of other long term care facilities. She has no family. She was an orphan. She's her own primary contact. And as I stated before, it's just not painkillers she seek, she wants all meds. When she was admitted into our facility, everyone knew she was a drug abuser and it's documented.
My thing is, I just want to protect me and my license by doing the right thing. So I have been documenting everything. This is the first time I've encountered a person like her. I just want to be in the right. You know? Her physician is very much aware of her behavior. Uh, oh!!! Time for me to go to work. You guys keep replying. It's helping me more than you know. God bless ya'll for the help. Ro
i am wondering "borderline" or whatever is the current dx....also, i wonder if she is truly alone, or family has abandon d/t difficulty dealing with her....
You all have been very helpful to me. More than you know. Again, this was my very first time experiencing someone's drug seeking behavior like this. But I knew if I prayed about this, the Lord would come through. He sent all of you to respond to my post. :) I just got home from work, and as usual, that particular patient was wanting her prn phenergan elixir, prn benadryl, and prn combivent at the time she could have it. And like you guys stated, "I documented, documented, and documented." If anyone else have anymore suggestions, please send them my way. Pleasseeeee! Thank you all soooo much.
Her doctor knows that she is a problem. She is 46 years old and in a nursing home. She should not be in a nursing home and if she wasnt in a nursing home she would probably be homeless and on the street. Her doctor is spineless, we all know atleast one like that. And I bet in this case the doctor is not the facility doctor. He's probably worried that if he doesnt give her what she wants, that she will get him in trouble. He is in deep, he knows he has created a monster. So he gives her what she wants.
I have experienced this.
Your DON does not care, as well as the administrator. The only way they will care is if the patient would start calling them directly. LOL Believe me. You can always offer their direct line if she complains that no one cares. Maybe they can find a facility that could BETTER suit her needs????
Or you can call HER doctors office with every little request. And document each time.
But as far as the orders for the drugs, you are in a losing battle. I have been there done that. And there is always that ONE nurse who will sympathize with her (LOL) "oh, we cant say she's not in pain, we arent in her shoes, blah bah", the one hippy nurse who makes all the other nurses look like meanies. (that nurse probably has a drug problem too. JK)
I am guessing at nite, ALL NITE LONG she has her TV on full blast, and all the lights on. And she is on that call lite. OMG I know that patient!! HA She went to your place after she left mine??!! (just kidding)
I am sorry, but you are in a losing battle. The meds are ordered you give them. But like others said, document. And call her doctor if you think her respirations are too slow and she is asking for more meds. Tell the doctor's nurse(as I am sure he wont speak to you directly,....unless its after office hours) that you are concerned she is too sedated, low respirations, and call several times a shift if you have too. This patient really does need help, and not the kind she is getting.
Having just recently attended a pain seminar. We were told pain is whatever the patient says it is. Try again to get her to a pain management clinic. Oxycodone IR and morphineIR are the two long acting pain meds available and usually can be given every 12 hours. She may still require something for breakthrough pain. Also Neurontin is something that might help. She may also require and adjunct such as something for depression. Instead of prn why not just make it routine. Patients of this nature tend to get anxious if they think someone is going to forget to offer them something for pain. This will also save time documenting prn's given.
There are patients who are drug seekers. Even with scheduled narcs, if there is ANY PRNs available, you can know that patient will be asking for what is available. So it turns out they end up getting even MORE when being scheduled than if it were just prn.
These patients are different from people who are truly in pain, they stay up all hours of the nite, every light is on, TV on, as well as in the day. They dont sleep because they dont want to miss their "fix".
This type of patient in a long term care facility makes it hard on the staff. Its horrible.
Rereading these posts, and I understand that this is a controversial issue, those in favor of medicating as per the pt request and doctors orders and those in favor of minimizing pt need for over-medications.
We have to remember that the pt is her own POA and makes her own decisions, if she wants the meds, and the doctor orders them, it is our obligation to educate her to the potential side effects and give them. We are not her conscience. We can ask for a cut off amount from the doctor for example up to 3 pills a day or whatever and we can do routine blood work to ensure liver function tests are normal etc, we can even try encouraging her to space out her meds more, but the bottom line is her right for the medication that the doctor ordered, we are not allowed to withhold her meds just because we think she shouldn't be having them!!
A good nurse would try to keep her distracted so she would have less of a need for the drugs- find out what her areas of interest are, and try to help her get busy, but a good nurse would not withhold her meds based on her own code of ethics,
Again a psych consult it essential and can help minimize or streamline her meds, ongoing psych treatment is advised.
Get the multidiscipline team involved, you are not in this alone, and separate you own feelings from the situation, what is right for you may not be right for the pt.
Make your goal to reduce the need for the excessive medications but do it gradually, nonjudgementally and with the proper help and support.
I know the type "drug seekers" but we are not suppose to judge. I would deffinetly talk to the MD and express your concerns and possibly get the orders clarified as far as the times and the prn for breakthrough pain also with the ''med seekers" dont they have orders to hold if lethargic or asleep? documentation is key CYA!!!!!
roro13us
42 Posts
The reason they accepted her into our facility is because she didn't have anywhere else to go. She's been kicked out of other long term care facilities. She has no family. She was an orphan. She's her own primary contact. And as I stated before, it's just not painkillers she seek, she wants all meds. When she was admitted into our facility, everyone knew she was a drug abuser and it's documented.
My thing is, I just want to protect me and my license by doing the right thing. So I have been documenting everything. This is the first time I've encountered a person like her. I just want to be in the right. You know? Her physician is very much aware of her behavior. Uh, oh!!! Time for me to go to work. You guys keep replying. It's helping me more than you know. God bless ya'll for the help. Ro