Drug Seeking Patients

Whispera, MSN, RN · Jul 2, 2011

I just tell them my reasoning once, and if they choose to argue I say I won't argue and walk away.

I also dig a bit to figure out their reasoning, before I make a decision. Sometimes they have reasons they don't tell me at first. Psych patients often have pain and anxiety and a history of taking pain and anti-anxiety meds. They can't just stop their habit because they're hospitalized.

Davey Do · Jul 3, 2011

We often hear the phrase "drug seeking Patients" in our work, which is a subjective perspective. This type of behavior is usually assigned to those Patients who make requests for some kind of controlled substance, be it a narcotic or a benzodiazepine.

All too often, we as Nurses feel we need to apply our personal beliefs, no matter how universal those beliefs are, to our work. We know that dependency to a controlled substance can yield dire results, both physiologically and behaviorally. As Professionals, we have the right to withhold medications if a non-therapeutic result is likely. Your example, nursemelyn, of a low BP is appropriate justification to withhold an antihypertensive or a controlled substance. But just because a Patient routinely requests a medication is not necessarily a reason to withhold it.

I do not recommend being stern or overly assertive in the cases of denying a Patient medication. Being stern conveys a power play and/or an emotional involvement. The reason a medication is withheld is based on an objectively logical assessment. It's all black and white. I've used lines such as, "The Doctor has prescribed this medication for you for a certain reason. I administer this medication based on my assessment of you. I provide service within the realms of my education and experience. My Professional belief is that to administer this medication to you at this time would not be therapeutic."

I will even go into detail, if need be. For example, Patients have requested a PRN benzo when other controlled substances had previously been administered. This criteria for prn administration of benzoes is typically for anxiety. I have noted that the Patients are smiling, have heavy lidded eyes, and slurred speech. Even though the med could be administered according to the time factor, I have opted to withhold it. I've given the Patients my rationale and they have reacted in different ways, from acceptance to wanting to argue.

For those who get "nasty", I tend to put on my professional face all the more. I have confronted Patients on any inappropriate behavior and then said things like, "I'm not here to win a popularity contest. I'm here to do a job to the best of my ability. I am sorry you don't agree with my decision. But, you don't have to like my decision- you only have to accept it."

When you say you don't know what to do, I sense you may be experiencing an inner conflict. You may be asking yourself, "Who do I please? The Patient? My Peer?" The answer, nursemelyn, is you. If you are acting within the scope of your professional practise, and are comfortable with your decisions, then your job is done.

However, if you're out to please everybody all the time, well then, that's another story.

The best to you.

Dave

nursemelyn · Jul 11, 2011

Thank you so much Whispera and Dave! I really appreciate your answers. I do have a problem trying to please everyone, so I will focus on making myself comfortable and helping my patients to the best of my ability.

GalRN · Jul 18, 2011

A unit that I worked on as a traveler had a rep for giving out MS Contin And oxy's like they were candy. Had a couple of pts that came in when their drug dealer went on vacation or their SSDI check ran out. They would stand and ask for whatever prn they had, nodding off, slurred speech and eyes at half mast. I would tell them that their sedation concerned me and they had to wait.

A couple of them hade IR meds for breakthrough pain, and were well aware when they were due. They asked repeatedly anyway. I just told them that if they couldn't remember the time and asked a second time that concerned me, because of their altered level of consciousness. That usually made them stop messing around.

I have been on the other side though. It stinks. I used to take lithium (had to switch to something less potent, toxicity) and have a hx of migraines. I used to get toxic from NSAIDS, common side effect. Went to the ER for anti emetics and fluids. Didn't ask for pain meds, they aren't worth the nausea for me. When the RN went to give me compazine I told her that I had experienced really bad akathisia in the past and requested that if she couldn't get the MD to order zofran, she at least give me benadryl at the same time- it helps some. She called me a med seeker and shut the curtain around the gurney I was on. I ended up with severe akathisia, and they knew it, but kept the curtain closed. Guess what, I WAS med seeking. The med I was seeking was benadryl! Still ****** at that hospital for treating me like a criminal as soon as I said no to the toradol. They hadn't heard of the interaction and made up their minds then.

Us crazy ppl aren't crebile right? That was extreme, but I stop and think before deciding that someone seeking meds is doing it to get hiigh

nursemelyn · Jul 20, 2011

I would tell them that their sedation concerned me and they had to wait.
I just told them that if they couldn't remember the time and asked a second time that concerned me, because of their altered level of consciousness. That usually made them stop messing around.
Us crazy ppl aren't crebile right? That was extreme, but I stop and think before deciding that someone seeking meds is doing it to get hiigh

Love the two tips at the top!!! :lol2:

And no, you're not crazy! All patients have a right to medication that works for them. I have decided that just because someone is in the hospital for psychosis doesn't mean that they don't know that Risperdal doesn't work for them. These people have lived in their bodies for a long time, a lot longer than the 5 minutes we've talked to them. Sorry if this doesn't make sense, I'm at the end of pulling a 16-hour shift :yawn:

GalRN · Jul 20, 2011

As my sis would say, tru dat! The risperdone made me think of a situation I was in about 10 yrs ago. Pt had a hx of non adherence. They put him on risperdone. For a few nights he paced, clearing his throat, saying it felt like a lump was preventing him from swallowing right. Had to be dystonia. Day staff thought he just didnt want the meds. Wouldn't d/c it. I finally got him to refuse the HS dose. No issues the next night. My job is to assess for barriers that could get in the way of tx. Side effects happen. We need to listen.

Abby315 · Jul 21, 2011

I would be very direct with them. Avoid getting into a "conversation" about the drugs they are seeking, dont give them any extra attention or say the words "I'm sorry" to them if you cant give them what they want. This will just make them think you will eventually give in. Even though it sounds "mean", I have family members who are addicts, as well as many clients where I work and I treat them the same way...

nursemelyn · Jul 22, 2011

Dont give them any extra attention or say the words "I'm sorry" to them if you cant give them what they want. This will just make them think you will eventually give in.

Thank you!!! I have such a hard time with this. Need to work on that. Eventually I'll be one dang good psych nurse thanks to all your comments!