Drug seekers "Drug of Choice"

mandrews · Aug 15, 2005

I have passed seven kidney stones that I know of and the er at the hospital I now work for never offered me pain control one time, no phenergan for the vomiting, and no fluids. My husband drove me an hour away to our hospitals main campus and I got the works. I came home and woke up in pain and I couldn't get it back under control. Made the hour+ journey again with me in the fetal position in the backseat, vomiting in a bucket. Today I shake my head in disbelief when I have to admit a woman with a sunburn who gets a morphine pca.

My 5 year old was in pain crying two weeks ago and went to the er. Xrayed and doc thinks possible vascular necrosis. discharged. I called from work and he was screaming in the background. Sent home early for low census and because they knew I needed to leave. I came home and he was a mess. He couldn't move to get out of bed to pee. *** ER folks when parents come in do not assume that they know what 400mg of ibuprofen or any other over the overcounter med is because my husband was giving my son 1 teaspoon. I gave him 3 teaspoons and a heat pad and he finally had some pain control after 10 hours. I really wondered why ER didn't give him the first dose before sending him home.

melissa

WhiteCaps · Aug 18, 2005

I don't know what the "drug of choice" is in our ER, but I do have another ER horror story.

My husband has a severe chronic pain condition. He received a prescription from our family doctor for po Dilaudid which he took to the pharmacy the next day (saturday) to be filled.

The pharmacy did not have the particular strength of the med to fill the script, insisting he would have to get the doc to change the strength to accomodate their supply. But, being a weekend, the doc was not on call & was out of town, leaving going to the ER our only option. (Using a different pharmacy is also a no-no... doesn't look good).

At the ER, we presented the intact prescription (from our family physician who is on staff at that hospital), explained the situation, asking only that the script be re-written to accomdate the pharmacy. We offerred to surrender the old script on the spot. And still, with all this, my husband was treated as a "seeker" by the ER doc!

After that humiliating experience, we went to the medical records department, examined the records of that ER visit and filed an appeal for amendment. The appeal was accepted and entered into his permanent record, and the physician also received notice of the amendment.

jaymee77 · Aug 18, 2005

i work for an involuntary treatment facility, i work with addicts every day. the forgotten point here also seems to be that addicts have A LOT of chronic pain issues. i can't even begin to describe the abuses that they put on their bodies when they are sick, and even when recovering, they have a really hard time dealing with pain. not only are they unaccustomed to it, but they have depleted many of the dopamine and natural pain relieving chemicals in their brains that allow them to manage pain through their use. i'm not advocating the rampant use of opiods to fix them up, but sometimes it is easy to label someone as a seeker without really seeking the reason behind the pain. we use toradol, neurontin, and other non opiate medications to treat chronic pain in conjunction with coping classes and relaxation. but i have seen recovering addicts deal with way larger amounts of pain without drugs than i would ever want to experience myself, and for that i have HUGE respect for those who commit to recovery.

Emma123 · Aug 18, 2005

Not everyone can afford a primary care doc, and in some states like mine, if you are over 18 no matter how poor you are or why you are poor, you do NOT get any medical or dental benefits. We have young folks coming in with horribly infected teeth who can't see the local dentist because they owe him money. So what should we do?say oh well suffer? We don't, antibiotics and pain med is needed and prescribed. Some people think we should treat dogs better than poor folks.
Can you imagine the kind of emotional/physical/spiritual pain that drives you to be an addict and then to submit yourself to the sneers and snickers of many ED staff(not all)? I will not allow that in my ED. We do our best to get these folks the help they need and we do find that many of the ones formerly called frequent flyers did have underlying medical problems that needed treatment.
We have started a pain clinic and some of these people have begun to find relief for the first time in many years. A kind explanation as to why continued narcotics is not the best way to handle their pain, prescriptions for alternatives and meds to prevent serious side affects of withdrawal and an appointment at the pain clinic(gratis) goes a long way with most and the others, maybe the sellers just move on.
I truly believe if we standardized the way we deal with chronic pain patients in the clinic and ED settings, like we do for Acute Coronary Syndrome, there would be no place for the truly devious to move on to.
I know they can be frustrating to deal with but they deserve to be treated with human compassion and dignity.
Eeyore

:yeah: :yeah: :yeahthat: :yeah: :yeah:

madwife2002, BSN, RN · Aug 18, 2005

Having just read all your horror stories I am speechless, which is a first for me. :eek:

What has happened to individualised care- and the that pain is what the patients says it is. :madface: I am not a chronic pain sufferer but i'd like to hope if Iwas unfortunate enough to require pain relief I would be able to access it. I also hope I'd have more compassion that some of the health care professionals described above.

And lastly when were nurses and doctors made up to be Judges and Juries.

sorry off soap box now :mad:

William_SRNA · Aug 18, 2005

Having just read all your horror stories I am speechless, which is a first for me.
What has happened to individualised care- and the that pain is what the patients says it is. I am not a chronic pain sufferer but i'd like to hope if Iwas unfortunate enough to require pain relief I would be able to access it. I also hope I'd have more compassion that some of the health care professionals described above.
And lastly when were nurses and doctors made up to be Judges and Juries.
sorry off soap box now

Pain is not what the patient always says it is. A 10/10 does not mean you can be sitting there watching TV and eating HOHOs and complaining of 10/10 migraine pain. I get so tired of this non-judgemental attituted in nursing. If I have a patient I ahve seen the last five days in a row in the ER wanting Demerol for a BS migraine you ain't getting it so be on your way and stop wasting my time

bluiis923 · Aug 18, 2005

Pain is not what the patient always says it is. A 10/10 does not mean you can be sitting there watching TV and eating HOHOs and complaining of 10/10 migraine pain. I get so tired of this non-judgemental attituted in nursing. If I have a patient I ahve seen the last five days in a row in the ER wanting Demerol for a BS migraine you ain't getting it so be on your way and stop wasting my time

lol hoop jumper....

Anyone have a Phenergan addict? We do.... comes in once or twice weekly for a shot of Phenergan. Usually gives different reasons for needing it each time.

z's playa · Aug 18, 2005

Pain is not what the patient always says it is. A 10/10 does not mean you can be sitting there watching TV and eating HOHOs and complaining of 10/10 migraine pain. I get so tired of this non-judgemental attituted in nursing. If I have a patient I ahve seen the last five days in a row in the ER wanting Demerol for a BS migraine you ain't getting it so be on your way and stop wasting my time

I started a thread concerning a migraine faker a while back. I lost it in the ER. I wasn't even a nsg student yet.

I agree with yeah..pain is what the pt says it is but there are times the objective data just doesn't support the subjective. ie; HOHOS and Coke for migraines. BTW...whats a HOHO?

Z

madwife2002, BSN, RN · Aug 18, 2005

Pain is not what the patient always says it is. A 10/10 does not mean you can be sitting there watching TV and eating HOHOs and complaining of 10/10 migraine pain. I get so tired of this non-judgemental attituted in nursing. If I have a patient I ahve seen the last five days in a row in the ER wanting Demerol for a BS migraine you ain't getting it so be on your way and stop wasting my time

I accept there are time wasters but the stories from people in this thread have been sufferers and treated badly as though they were drug addicts and crying wolf.

slo · Aug 18, 2005

What do the drug seekers coming into your ER ask for most? In our ER it seems to be Vicodin or oxycontin.
What is their usual complaint? In our ER it usually is back pain with pain radiating down the leg. Sometimes they will limp.
Do you have ANY ER Doctors with the Balls to order a non Narcotic? We do. Its cut down on our repeat offenders! Can lead to some very entertaining and loud discussions behind those pt curtains....
Ever have a repeat offender that went really bad? We did. Came in as an overdose after a year of weekly visit for refills of Vicodin for uncontrolable back pain and spasms. Died. Found out later his main income was reselling his pills to those in the area and online. Family sued the Dr and facility for allowing him to become addicted..... and won.

Do you have any docs with the Balls to prescribe / administer pain medication? We don't. Everyone is so concerned with the DEA and license regulation. Let's give them toradol to go along with the bleeding ulcer they present with. Then follow up with some naproxen and wash it down with prevacid. IMO, it doesn't take a doc with Balls to not treat as needed. Drug seeking is one topic--pain treatment is another.

Danianne · Aug 18, 2005

I agree that there are a lot of drug seekers out there... how sad. It really really bugs me when people who just want drugs get better treatment than those who actually have a reason for NEEDING the pain meds. I went through absolute hell for 3yrs from undiagnosed gallbladder problems, I was in th E.D. sooooo much for horrible abd pain and I was labled a faker. so when a stone finally blocked the bile duct aand I turned all yellow and septic from it and refused to go to the hosp again... i am sure you all get the point.

button2cute · Aug 18, 2005

Pain is not what the patient always says it is. A 10/10 does not mean you can be sitting there watching TV and eating HOHOs and complaining of 10/10 migraine pain. I get so tired of this non-judgemental attituted in nursing. If I have a patient I ahve seen the last five days in a row in the ER wanting Demerol for a BS migraine you ain't getting it so be on your way and stop wasting my time

Hello, All

Hoop _jumper, you are one of numerous nurses that need a education about acute and chronic pain and treatment of chronic pain, re-education of how to treat individuals as individuals and to be relocated on another unit for six months and re-introduce into the ER once again.

Many nurses in the ER are immune to people's illness, diseases, injuries and the emotions of their patients. The nurses build up a harden skin and attitude over time which is why they cannot feel a thing about their patients. Many of them, feel they had been abused or snowed by the frequent flyiers which justified their behaviors toward the patients. However, it should not occur because one day they will be held liable for their actions of taking care of a patient. Then it will be too late to help the patient/s and tne nurse/s. Therefore, a program or numerous program should be in place to reduce the harden nurses and physicians and the frequent fliers.

I truely believe once a nurse becomes harden than one becomes ineffective as a nurse on a particular unit and caring for patients. I thought of numerous of ways to identify these nurses/physicians and to began a 24 weeks of rehab. for them. It would be a mandatory and a volunteer program for the ER, ICU, MED. Surg., Teli, PICU, SICU, NEONATAL ICU, or any other areas that identifies as high stress, risk, demanding, and does not allow you to express your emotions about a case or a patient.

I thought of re-education in patient care and the purpose of being a nurse; acute and chronic pain education and clinical experience in a pain management program for at least six weeks; education in sensitivity of the chronic, acute, intermediate disease/illed patients and culture; counseling to discover why they became the way they did, stress-releasers, and to find resolutions and not to add to the problem; reassignment to another floor that can assist in their desensitivity of patients as well to reduce the stress and lastly, each week after the return to their units for six months or longer a two hour session to be conducted by the therapist and the educator to discuss any problems and to see their progress.

I know several may disagree of my thoughts and it is alright to agree to disagree. When a new policy is in place we all tend to resist it because it is human nature. Well, just think about for a bit before reacting. It may or may not help the individuals and the patients and readjustment maybe require. (Oh, Yes, you will be paid at the same rate in your assign unit and your hours may change according to the schedule for day time participation in the various education and clinical programs.) It will definitely prevent any nurses going down for neglect, abuse and the escape goat for other health care professionals. Never lose a license over a situation that you can control and to readjust your actions for the benefit your license.

Remember you all have heard this from me.....and when this program becomes establish.....think of me.....because I will make it work, prevent any nurse going down in the hands of those who are abusing them as well as the escape goat for other health professionals and make them stronger mentally, emotionally as well as a nurse.

Oh, for the one who jumped on the Hoop_Jumper's band wagon, if you do not know what a hoho is? then how can you take a ride on the band wagon? A HOHO is a cake with vanilla creme in the middle with chocolate cake and icing on the outside. Therefore, do not jump on the band wagon unless you understand everything in the message that Hoop_Jumper is saying to all of us.

Hoop_Jumper.....I hope you do not make a mistake about a patient because of the abuse you had taken by the fakers.....remember it is your license and it only takes one call.

Have a great evening and day.

Buttons