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.
I have a sister with fibromyalgia and a "bulging" disc who is in excruitiating pain. Today she was complaining to me how no one will treat her pain. She is very angry. She is on ultram, (wants prednisone again, says lortabs help but they won't give them to her...excuse my spelling!). I don't know enough to give her any good advice (I am an aide, don't even know what these drugs are!) I did ask her if the doctor suggested surgery to repair the disc, and she said NO WAY would she ever do that. It is so hard for her to function, and I am not sure what kind of physician she should see for help.
Hello,
Ask her physician to send her to a really good pain center. In addition, if she wants to continue her work in society than she ust understand narcs can cause sides. These side effects can give a person-tiredness, blurr vision and disrupt the thought process as well as many more side effects. In addition, her goal is pain control and maybe the pain center could posibilityfind a suitable resolution for her. I have a really great sister of mine, who is encountering this nasty disease and how uncomfortable it can be at times.
Therefore, just ask the DR about the pain center, tia chia is very good in control as well as other therapeutic programs that will reduce the pain.
Ask her physician to send her to a really good pain center.
Have a great day, evening and weekend,
Buttons.
I think this is a really great idea. I have had fibromyalgia for 30 years. It started in nursing school when I was 17 and started in my shoulder. For years I didn't know what it was but I knew something was very wrong. When I was 29 I went to a rheumatologist, by this time it had spread to the other shoulder and my hips and elbows (and about 15 trigger points). I was treated by the rheumatologist for years. 3 years ago I started in a pain clinic, and that is where I received the most relief. I am now on ms contin, neurontin and elavil (at hs for sleep) and I am going for a procedure next month (a rhizotomy) for the facet joints in my lower spine. Hopefully, I will then be able to cut out the narcotic. Fibromyalgia is a terrible and misunderstood syndrome, and I would not expect an ER doctor or nurse to know what it is or how they should treat me. That is why I would never go to an ER with problems such as poor pain control. I would call my pain clinic during business hours and only go to the ER with a life threatening condition. It is all about medical necessity anyway.
As for the problems with seekers in ER's, my thoughts are there should be some kind of local database linking all the hospital ER's, run the name through and see where else they have been and what kind of treatment they received there. And what about a urine drug screen first, before any other tests are done or meds prescribed. It is just a thought, I don't know how long the test takes, or how expensive, but I am thinking if the urine drug screen is done first, then at least you have a better idea what you are dealing with.
Thanks for these replies about my sisters fibro and disc problem. She was recently referred to a pain management center, who refused her. She said they said that they do not do fibromyalgia. I am going to urge her to try again. Possibly the disc problem will open a door for her. Thanks!
Pain management, acute and chronic should be a seperate course in nursing school. It can be a complex issue involving assessment, pt. hx. dx., etc. In my opinion, potential for addiction for reasons other than quality of life and normal functioning could possibly be emphasized in such a course integrating what you've learned in abnormal, pharm, community, rural and mental health curriculum. Might be a good project for a masters or doctorate level thesis.
It's too bad opioids are getting a bad rap because of all the intentional abuse. Personally, I have an ongoing script for lortab. I take 200mg Ketoprofen SR for chronic arthritis. It's about the only nsaid that doesn't churn my stomach, and I've tried most of them. For acute attacks, I have an ongoing script for Lortab. It's a godsend. If I need a little help, split one in half. For worse pain, take one and if things are unbearable, I can take two. It's the only pain killer that I can function with cognitively and the only one that never constipates me or upsets my stomach. I am a junior in nursing school with a 3.56 gpa.
Pain management, acute and chronic should be a seperate course in nursing school. It can be a complex issue involving assessment, pt. hx. dx., etc. In my opinion, potential for addiction for reasons other than quality of life and normal functioning could possibly be emphasized in such a course integrating what you've learned in abnormal, pharm, community, rural and mental health curriculum. Might be a good project for a masters or doctorate level thesis.
It's too bad opioids are getting a bad rap because of all the intentional abuse. Personally, I have an ongoing script for lortab. I take 200mg Ketoprofen SR for chronic arthritis. It's about the only nsaid that doesn't churn my stomach, and I've tried most of them. For acute attacks, I have an ongoing script for Lortab. It's a godsend. If I need a little help, split one in half. For worse pain, take one and if things are unbearable, I can take two. It's the only pain killer that I can function with cognitively and the only one that never constipates me or upsets my stomach. I am a junior in nursing school with a 3.56 gpa.
G
Hello, All
I do not take any narcotics at all for my back injury. The reasons for the decision are the following:
1. You may not drive on narcotics or operate any machinery because it may delay
your reaction time.
2. The congnitive may be disrupted or inappropriate judgement during working hours.
You can be dismiss from work for using narcotics, prosecuted for errors that
occur under the usage of narcotics, and etc.
3. The side effects of the narcotics may or may not disturb your normal routines and
activities.
I chose to use other types of medications for the control the 4/10 and the pain that is 6 and higher out of 10 then my dr and I discuss the treatment. I will not allow myself to be in trouble over narcotics at the work site as well as driving. My dr always tell other patients and myself about driving on narcotics and if you are caught then you will not have a leg to stand on. Therefore, I have use other treatments to treat my pain when it is 4/10 and I can continue my pursue of working at an appropriate work site.
I would never go to the ER because I have seen how they treat other patients with pain. I can bring my prescriptions into the ER for verification as well as my medical record. Would this change the attitude and treatment I would recieve for the ER staff? Probably not, I will not go to ER as long I can breath and my heart beats. I will meet my physician/s at the ER for treatment only. My choice and if I shall die for the wrong judgement than at least I would not be in a negative and ineffective treatment area by the ER staff.
I know it is ashame that I do not trust the ER nurses and Doctors. Because I am a nurse and I should trust other nurses to treat me as if I was their own family member.
Thanks for these replies about my sisters fibro and disc problem. She was recently referred to a pain management center, who refused her. She said they said that they do not do fibromyalgia. I am going to urge her to try again. Possibly the disc problem will open a door for her. Thanks!
I've been seeing a specialist in Pain Management since August of 2003, when I was diagnosed with a herniated disc between L3-L4, and my Orthopods told me that I was not a surgical candidate. I've had a total of six ESI's since, which have only helped temporarily. Despite this, I have developed a therapeutic relationship with him and his staff, who have done everything BUT turn their backs on me, when I thought I was going to go OUT of my mind between the alternating screaming pain and nauseating numbness that goes along with the territory. Tell your sister that she has nothing to lose, and everything to gain, by trying again. :)
the bottom line is that until they invent the perfect lie-detector test (pain-detector test?), we will end up doing one of two things: not treating some of those who are in pain, or giving narcs to some who are seeking. i would rather err on the side of medicating the seekers, and i would hope that most nurses feel the same, though i understand how jaded one can get.
that being said, the drugs of choice in our er seeems to be lortab and demerol.
to whitecaps:
i tried to imagine myself as the triage nurse when your husband came in with the dilaudid rx, and how i and the er where i work occasionally would have responded. while i would never treat you/your husband as a "seeker" for this request, i don't think you would have gotten that script changed in our er very easily. not because any of the docs there would have assumeded you were seeking narcs, but just because it isn't good practice. none of those doctors had worked him up/treated him. he may have had a valid script, but the er doc who would have been writing the new script didn't have a threapeutic relationship with your husband. not a good idea for any medicine, but especially narcs. and it is very unfortunate that things are that way. good practice would dictate that your doctor would have had someone covering for him while he was out of town, and that is who should have changed the script. i'm not sure, though, why the pharmacy couldn't substitute the correct amount of dilaudid from what they had on hand, but then i know that dea regs are complex and strict. anyway, i'm so sorry you and your husband were treated so poorly.
thanks critter lover!
unfortunately in our small town, the doc has no partners and his phone directs problems to the er when he's unavailable. my husband was standing right there, if they wanted to develop a therapeutic relationship, they could have. another point here is that most doc's have met my husband and his charts at the same hospital have to be a foot thick from previous hospitalizations. they could have given him a smaller quantity to make it thru the weekend. it was cruel.
bottom line...... yes! we absolutely need a "pain detector machine"! let's invent it and retire wealthy!
I am appalled at your opinion of pain management in the ER! You won't go there so long as you can breathe or your heart beats? Well, I hope you never utter that to an ER nurse who may have the misfortune of treating you.
You believe taking your prescriptions to the ER wouldn't change things? On the contrary, if someone can show me they are usually on, say Dihydrocodine, I'll make sure they get the next drug up on the opiate level if they come in complaining of pain.
Your attitude, to be frank, brings down the reputation of emergency nurses and with it every other nurse in the hospital. If you can't trust a nurse, who can? Are you sure you are cut out to be a nurse?
I know 100% that I strive to do my best for each and every patient - even if it means sticking my neck out infront of the doctors.
I feel very sorry for you and hope you find a way of getting over this very strange barrier you have. Perhaps you have had a bad experience in the past, but PLEASE do not tar every emergency nurse with the same brush, its only more likely to get peoples backs up and make them seem resentful to you.
Best of luck.
I would never go to the ER because I have seen how they treat other patients with pain. I can bring my prescriptions into the ER for verification as well as my medical record. Would this change the attitude and treatment I would recieve for the ER staff? Probably not, I will not go to ER as long I can breath and my heart beats. I will meet my physician/s at the ER for treatment only. My choice and if I shall die for the wrong judgement than at least I would not be in a negative and ineffective treatment area by the ER staff.
I know it is ashame that I do not trust the ER nurses and Doctors. Because I am a nurse and I should trust other nurses to treat me as if I was their own family member.
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
Hurrah! Judgment is EXACTLY what we are required to do when assessing a patient. But that's not ALL! We may write(as with the old SOAP notes) what the patient SAYS about his pain, but as educated professionals it is also our job to use the O: and A: parts of an assessement. Although pain is subjective and subject to personal pararmeters, observation can tell a lot. Severe abdominal pain without guarding, is suspect. I work in a juvenile prison and I have seen some academy award winning performances. Everything from Migraines, to schizophrenic episodes. Narcotics are not the only thing being sought.(although we don't have any narcotics in the place) Sometimes its a night out of the cell and in the nice airconditioned med dept. You must be a medical detective. For the patients sake, your license's sake, and for the preservation of that deep down quality that brought us to nursing in the first place. That means a VERY thorough evaluation of any complaints of pain. I've developed a few tricks up my sleeves over the years such as having the I/M wait in the waiting room and observing him on close circuit, thumbing through brochures,lying flat on the bench etc. HOWEVER, and I do mean HOWEVER, after my THOROUGH evaluation, the I/M is refered to the doctor, and specific tests are performed to R/O any pathology.Maybe a rectal(often when getting a signed consent for that, the I/m has a spontaneous and miraculous recovery). Denial of pain med or whatever the I/M is seeking is based on FACT. We will send an I/M to the local ED for a CT, Xray, stat labs or whatever is called for before JUDGING that he is feigning. Judgments not jumping to conclusions. Usually our judgements are correct and there is NO pathology. But on more than one occasions I have been greatfull that our Docs get all their facts together before calling their bluff....Proper investigation before condemnation. Isn't that how it's supposed to be? I am lucky that I work in an enviornment that is conducive to rendering the best possible care available. I am never in fear that I might be party to a negligence lawsuit. I will say I have personally misjudged a c/o pain (but kept THAT to myself) and found out after careful examination and proper referal that there WAS a serious problem.
I am appalled at your opinion of pain management in the ER! You won't go there so long as you can breathe or your heart beats? Well, I hope you never utter that to an ER nurse who may have the misfortune of treating you.
You believe taking your prescriptions to the ER wouldn't change things? On the contrary, if someone can show me they are usually on, say Dihydrocodine, I'll make sure they get the next drug up on the opiate level if they come in complaining of pain.
Your attitude, to be frank, brings down the reputation of emergency nurses and with it every other nurse in the hospital. If you can't trust a nurse, who can? Are you sure you are cut out to be a nurse?
I know 100% that I strive to do my best for each and every patient - even if it means sticking my neck out infront of the doctors.
I feel very sorry for you and hope you find a way of getting over this very strange barrier you have. Perhaps you have had a bad experience in the past, but PLEASE do not tar every emergency nurse with the same brush, its only more likely to get peoples backs up and make them seem resentful to you.
Best of luck.
I am sure you do your best for each and every patient but not every physician and nurse does. A good many of them are extremely judgemental of anyone who shows up in their ER requesting something for pain. They tend to view them as addicts, looking to score. They tend to question everything the patient says and are judgemental of their presenting symptoms. If one doesn't act like they think they should be, then one is labeled as drug seeker. Perhaps they should learn not to tar everyone who shows up in their ER with the same brush and label. Perhaps they should learn the difference between a true addict and someone who requires somethinger stronger. And knows it.
As a nurse on a med surg floor, we get many pain sufferers, questionably drug seekers. I agree that these patients have a problem, many of which started out as pain. Dilaudid seems to flow like water in our hospital, though. It just seems to me that if you can complain of 10/10 pain, cry for Dilaudid, get the Dilaudid 2mg IV, then literally hop of fthe bed (and I mean immediately after the drug gets on the pump, because we rarely push it) and leave the floor to go smoke, there is a problem. It happens constantly in my facility. And no, it isn't everyone. We get people who have legitimate medical complaints, but they aren't caught in the cafeteria, out smoking, etc. Seekers manipulate and they know how to get their fix. I just hate that people who are really in pain and really sick have their time with a nurse stolen by someone who knows they can complain of "abdominal pain" just to get a high. There really must be a better way to help these people. They really are sick, but giving them more of what they want isn't helping anyone. They need help that an acute care hospital isn't designed for. We aren't a rehab.
I have to comment on this thread and say again, who are we as nurses to judge all people who come into the ER department and decide that the patients pain is not real. Obviously anybody who comes into the ER for pain relief and is not in pain but an addict still has a problem, because it isn't normal for somebody to want medication when they dont need it.
It frightens me to think some nurse have become so hardened to the delivery of pain relief, that geunine cases are being treated as such. Surely this is their job and they get paid for working in the ER dept, I dont suppose anybody works for free and gives up their spare time to go and look after 'time wasters'. Good job you dont work in UK where all the poor ER nurses and doc's do every fri sat and sun night is deal with drunks, then you would have something to moan about. :stone
button2cute
233 Posts
Hello,
Ask her physician to send her to a really good pain center. In addition, if she wants to continue her work in society than she ust understand narcs can cause sides. These side effects can give a person-tiredness, blurr vision and disrupt the thought process as well as many more side effects. In addition, her goal is pain control and maybe the pain center could posibilityfind a suitable resolution for her. I have a really great sister of mine, who is encountering this nasty disease and how uncomfortable it can be at times.
Therefore, just ask the DR about the pain center, tia chia is very good in control as well as other therapeutic programs that will reduce the pain.
Have a great day, evening and weekend,
Buttons