Drug seekers

[russianbear]

I'm sure this has been posted before and I would appreciate any links to good threads on the topic. I am a new nurse and struggle with giving strong opiates like Dilaudid, etc to people who are clearly pain seeking. I feel dirty. Yesterday I had a gentleman who was ordered 1mg Q6. He was a clock watcher. As soon as that six hours was up, he was on the light. The reason he was getting this is because during the previous shift he threw such a fit yelling, screaming etc to have it the physician ordered it. Looking through his history, this is his pattern. Usually in the ER he yells and screams and demands IV Dilaudid. In this country there are a lot of people addicted to opiates because they are often over prescribed and these types of things feeds into that. As a nurse, one of our responsibilities is to encourage health and I feel more like I am contributing to a societal problem than helping a patient in situations such as this.

I don't want this to be a "pain is what the patient says it is" argument. I am talking about the rare instances where someone is clearly a drug-seeker.

[Jensmom7, BSN, RN]

That was the whole problem. The nurses in that unit were not trained in hospice. There were no full time hospice nurses there because they didn't always have patients in the inpatient unit. The nurses were all floated from med/surg & had zero training in hospice philosophy. The only actual hospice nurse they had was in the corporate office & only available on day shift. We had to have the hospital administrator on call contact the hospice physician at 1 in the morning & he ordered a morphine drip. He also had a long talk (on the phone) with the night nurse& made it clear she was to titrate the drip to my dad's comfort & not to withhold it.

Had we known all this before he was admitted there, we would have chosen a different hospice. It was a horrible experience!

The thing is, even though the hospital staff were supplying the care it was Hospice who developed the care plan. There should have been an RN assigned to his case, as a resource for the hospital staff, especially since the inpatient unit doesn't utilize dedicated Hospice staff.

I've not heard of a Hospice agency that didn't have someone available after hours, both to discuss issues and make a visit to evaluate symptom management.

If that was indeed the case, the Hospice agency should have made it clear during the informational visit prior to admission (or at the time of admission if things were more rushed).

[ixchel]

This thread has become annoying...

Ironically, until you bumped it, it died about 2 weeks ago.

[canigraduate]

Ironically, until you bumped it, it died about 2 weeks ago.

LOL! My first thought when I saw that post was, "Then why did you revive it?"