Drug seekers

[SierraBravo]

I have a good friend who is a nurse on a busy med/surg unit and she was telling me about this chronic patient that seems to get readmitted to her unit every 3-4 weeks for a variety of reasons. The patient is a known drug seeker to the ED and the medical team. The issue is that this patient demands that his IV narcotics be pushed (and pushed fast) so as to elicit a "buzz" from the dose. She was telling me that if the nurses don't comply with the patient's demands that he becomes beligerent. Aside from the fact that pushing narcotics too fast can cause hypotension, what would you say to the patient to help him understand that the purpose of narcotics is pain relief, not to get a "buzz"? Unfortunately, after discussions with the MD's, they have no input on the matter and leave the IV narcotic orders in place.

[morte, LPN, LVN]

there is no education for this type patient, all nurses need to get on the same page and refuse.

[LakeEmerald]

How about hanging the med instead of pushing it? If not contraindicated, a 50 or 100mL NS drip over 5-10 minutes would deliver the dose without giving the patient a buzz. Pushing it too fast, (by nurse in a hurry, and I usually am) can cause euphoria, which wears off quickly (usually within 15 minutes). This seems to create the perception that more narcs are needed and and they are right back on the call light.

If my patients ask why their pain meds are hanging instead of being pushed, then they know WAY too much about IV narcs. But most patients are content to get their "pain drip." If I'm asked, I tell patients that their pain relief will last longer this way. I haven't researched this, but it seems to make sense, because it should take a little longer for the medication to reach its peak and taper off. BTW, true druggies know how to open up the clamp on their line, so placing the drip on a pump is an option that usually stumps them.

There's nothing wrong, however, with saying to a belligerent patient demanding a fast push, "I'm not here to get you high - you can do that on your own time."

Hanging narcs in a drip frees your hands up so you can do other things. Let's face it, leaning over a patient's arm for 5 minutes to push a pain med is simply unproductive, IMO.

BTW, I work in the ED and this is acceptable in my department, not sure about other hospitals/departments.

[Rexie]

I work on a med/surg unit that gets our fair share of frequent flyers that seem to be drug seeking. I push my pt's IV narcotics over 2 minutes. Some of them become upset but I explain to them that it is safer that way and I'm a "by the book" kind of nurse. Some of them accept that and some get angry. Usually, I'll explain to the pt why I push meds slow and I've actually had pt's thank me because another nurse did push fast and the rush they felt was unpleasant. But those are the opiate naive pts.

Without getting the doctors on board, I'm not sure what you can do. Most of our doctors are as tired of the drug seekers as we are. They're pretty good about switching patients over to PO's ASAP but if for some reason they can't, they'll order the morphine or dilaudid to be given sc. They say it's supposed to make the med release more slowly and the pain relief to last longer.

I agree that all the nurses need to be on the same page (as well as the rest of the healthcare team). And they may be. I don't know how many drug seekers have told me that I am the only nurse who pushes their med slow. Sure...... My coworker all hear the same thing.

Other than educating the patient that they're only going to receive what is ordered and it not be pushed fast, there's not much else we can do.

[RNtoCRNA22]

Do you have a psych consult available at your hospital? If not, maybe a social worker would be a great resource to use to refer this pt to a substance abuse center upon discharge. Unfortunately drug seekers have learned how to abuse the system to get what they want, even if it's just for a brief period.

The other thing that might be helpful is to see if there is a written protocol in your hospital about how quickly (or slowly I should say) narcotic pain killers can be administered via IV push. If you can find the documentation about that, you can always just say that it is simply against policy. Also, reassuring the pt that you are really there to help them may aid in reducing the belligerent behavior. Hope this helps!

[hppygr8ful, ASN, RN, EMT-I]

Do you have a psych consult available at your hospital? If not, maybe a social worker would be a great resource to use to refer this pt to a substance abuse center upon discharge.

This America and a person cannot be forced into substance abuse treatment against their will. Even when the court mandates treatments the addict has to make the choice of compliance with the court order. Under the Lanterman Petrie Short act a person may not be hospitalized against their will unless they present as a clear danger to themselves or others or are judged to be Gravely disabled by reason of mental disease. Most insurance does not cover drug treatment for non-compliant patients. Conversations about addiction and dependency need to start in the Doctor's office between the Doctor and Patient not in the acute care facility where most nurses and doctor's alike have very little understanding psycho-dynamics involved.

A nurse should never do what is unsafe or against protocol or their Nurse Practice Act simply because a patient demands it.

Peace and Namaste

Hppy

[NOADLS]

I have a good friend who is a nurse on a busy med/surg unit and she was telling me about this chronic patient that seems to get readmitted to her unit every 3-4 weeks for a variety of reasons. The patient is a known drug seeker to the ED and the medical team. The issue is that this patient demands that his IV narcotics be pushed (and pushed fast) so as to elicit a "buzz" from the dose. She was telling me that if the nurses don't comply with the patient's demands that he becomes beligerent

Caving in to this patients unreasonable demands is not the solution. Documented education regarding risks of the patient's requests and documented instances of behaviors will be the precursor to this patient ending up in handcuffs during their visits when they get out of hand.

[calivianya, BSN, RN]

Caving in to this patients unreasonable demands is not the solution. Documented education regarding risks of the patient's requests and documented instances of behaviors will be the precursor to this patient ending up in handcuffs during their visits when they get out of hand.

Wish I'd seen this happen before. It's more likely to have management sit down with the nurse to have a talk about why the patient fired that particular nurse and how it's going to impact satisfaction scores...