This week, I have officially become sick, tired, and disgusted with the drug-seeking behaviors and, in addition, the Press Ganey-brainwashed administration that condones them.
Patient comes to ED for "torso" pain (trying to be vague), straightfaced in a gown standing @ TV in room flipping through channels and going on and on on her cell phone about how someone owes her money. Seeing me, she comes over to the bed, sits down, and says "Go ahead," sticking out her arm while still talking away on her cell. I kindly explain that I need to ask questions and assess prior to pain meds, and will wait until she's finished with phone conversation. Of course, phone is hung up pronto. Upon sticking her arm out for me, multiple track marks, red infected areas that look like brown recluse bites (from dirty needle use), OK. I ask if there is IV drug use, and get a shocked-meets-almost-offended "Oh god, no. I've been in the hospital and stuck so much, they can't ever get a vein."
Long story short, friends show up (that my patient actually wants in the room), and they ask if they can talk to me. I go in the privacy room and they start going ON and ON about the patient's heroin and now pain med addiction, and that she needs help, and we need to make her get help, etc etc etc. During this, I share no info, only nodding and saying, "Ok..." Upon asking patient about contradicting info, she is again very surprised and denies ever having used heroin, as well as everything else.
So, she wants friends in room. Friends go in, and in front of me, confront her. Eventually she admits to issues, and still wants pain meds. Thankfully, goes home with an rx for Motrin. :) STILL. Gave her Dilaudid and Toradol prior to Intervention. And I've given her 10mg Dilaudid over the past 2 weeks in various visits. And we have another patient that comes in with back pain, pain is a 9/10, gets Dilaudid 2mg + Zofran 4mg IV, pain is then 8/10, gets another Dilaudid 2mg IV, pain is 6/10, and is discharged. EVERY TIME. Like 14-15 visits since 8/1/08. Other patients, same stuff. Dilaudid, dilaudid, dilaudid.
Similar patient went to administration because pain was not treated how she thought it should be... doc got chewed a new a-hole, and what good does that do? Do whatever you can to please your patient, even if it means feeding a drug addiction? I honestly HATE this. I chart like the queen b-tch, noting facial expressions, behaviors, grimace, guarding, moaning with no tears, laughing with friend in rm, watching tv and drinking mountain dew though nauseated and in severe abdominal pain, etc -- still, our docs are just as fed up but in talking about this, have literally said, "After Dr. Got-chewed-out got called in to whoever's office the other day, I'll put them in a Dilaudid coma if I have to. Whatever will make the patient happy, right?"
Since when did pain become so freaking terrible? I personally would rather be in some pain than be completely numb to my life as a whole. Me and most of the ER staff:
Sorry, and thanks for listening! As the title says, I feel like a legalized dope dealer, and it makes me incredibly uncomfortable. Hrm!
I'm a student, and I agree that this is probably one of those situations that will make me question a lot about the way things are. But if it's any small consolation (admittedly really small), at least the druggie is getting his/her fix from the hospital and not beating up some old lady trying to get money for street drugs.
Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
Would you be cool with your doctor or nurse, pilot or police officers taking legalized drugs? I would not be.
Well those people probably wouldn't even be working - I mean heck, why work when you can legally stay home and get f****ing high all day long, oh, AND go on some liberal/socialistic program like SSI/disability to help pay for your habit!!!!
i work on the med/surg floor and we certainly see our share of the drug seekers. we have one who comes in with exac of chrohns who sets her cell phone to go off 20 min before meds are due to remind us. she is very demanding and treats us like we are the local hilton. with patients like these (and the docs who placate them) it is easiest just to placate them. as an lpn i can't give her iv meds having to rely on the rn to do that. the night goes much smoother if the rn just gives the meds when she asks for them (following orders for time frame of course). i had one nurse who wouldn't give her the meds till she did this or that because she didn't think she needed them. then got upset when pt kept asking. it is hard to change the patient and until they are ready for a change, pointless to try.
I would just like to say thank you to those of you who let these patients know that they are not kidding anyone with their behavior. My sister is a drug seeker and I can not tell you how heartbreaking it is to hear that she has managed to get another prescription from another hospital or practitioner.
I want you to know that I am silently CHEERING YOU ON and giving you a RIGHT ON and YOU GO! everytime I listen to my sister tearfully complain about you. You restore my faith in health care. It hurts to think of the doctor, hospital or nurse as a drug pusher.
I know she goes ballistic on you and everyone else. I know she lies and lies and lies to you (while talking on her cell phone about how much pain she is in). I know she plays the victim and I know she usually gets what she wants but THANKS for calling bulls--t when you see it! :redbeathe
All the time I think about the two nurses, one doctor and a pharmacist who at least tried to save her from herself.
Thanks and lots and lots and lots of hugs.
(PS please do not take it wrong if you said you don't confront drug seekers b/c I don't confront her everytime she does it either!)
Specializes in Telemetry, ICU, Resource Pool, Dialysis.
My policy has always been: If they want it, and it's ordered, and it's due, they get it. I'm not a drug rehab nurse, it's not my job (like I have the time) to encourage people to stop using their prescribed drug of choice. I have too many other things to do. To keep doing the job, you just CAN'T let it get under your skin.
My favorite line is, "Seriously, you have to push it real fast, otherwise it doesn't work AT ALL. My doctor even said it's OK."
Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
My policy has always been: If they want it, and it's ordered, and it's due, they get it. I'm not a drug rehab nurse, it's not my job (like I have the time) to encourage people to stop using their prescribed drug of choice. I have too many other things to do. To keep doing the job, you just CAN'T let it get under your skin.
My favorite line is, "Seriously, you have to push it real fast, otherwise it doesn't work AT ALL. My doctor even said it's OK."
Yeah, sure....
Here's a good one... next time you're about to push 2mg of Dilaudid IV - confer with your ER attending and ask if you can mix it in a 50 cc bag of NS and run it in over 30-60 minute (on a pump with a pt lockout). You could justify it by saying the slower infusion would give you more opportunity to monitor for side effects...!!!!!
Thanks for all the supportive comments. Glad I'm not the only one that gets tired on occasion of dealing out the dope. I was not by any means looking for advice... :)
Here in Indiana we can look up all controlled substance scripts that a patient has had filled in any pharmacy in the state and who prescribed them. Had a lady a couple weeks ago who had recieved over 300 vicodin in a one month period from like 15 different ER's and when confronted by our awsome doc that day and when she denied and shown the print out of all her scripts and doctor shopping. But she came back and Dr. People Pleaser was on and he even looked her up and saw all those scripts but he still wrote her another script for 20 vicodin and I wanted to vomit as I gave it to her and she smiled and asked me what days he worked!!! Of course I did not tell her but I was so mad!!!!
My policy has always been: If they want it, and it's ordered, and it's due, they get it. I'm not a drug rehab nurse, it's not my job (like I have the time) to encourage people to stop using their prescribed drug of choice. I have too many other things to do. To keep doing the job, you just CAN'T let it get under your skin.
My favorite line is, "Seriously, you have to push it real fast, otherwise it doesn't work AT ALL. My doctor even said it's OK."
Yeah, sure....
you know, I may have to give it when ordered and asked for when due, but that order does not include lowest port at warp speed. Sorry, that line just bought you a very slow and cautious push.
hpcat
116 Posts
I'm a student, and I agree that this is probably one of those situations that will make me question a lot about the way things are. But if it's any small consolation (admittedly really small), at least the druggie is getting his/her fix from the hospital and not beating up some old lady trying to get money for street drugs.