abusers and losers. Can you top this one? - page 2

Last monday, I had a lady come into triage with a godawful, pity-me limp. She proceeded to tell me that she had terrible pain from her low back radiating into her left leg. She offered up that... Read More

  1. by   canoehead
    It's really sad that when someone comes to vent on this BB about a drugseeker stealing meds that a half dozen people have to post just to make sure she didn't neglect someone in true pain. I think she was very patient and caring with this woman, and wish we could assume the best of our fellow nurses instead of the worst.
  2. by   amk1964
    The story is a familiar one. I have to say though that I don't get upset with the seekers as we all know they have their pt rights and if there's a physicians order and the pt has stable vs...give it . Save yourself the time and energy to try and bash them or rehab them...its futile.
  3. by   gwenith
    Thank-you Canoehead well said.

    I found out many yeara ago just how accurate a nurses' "Bulldust Barometer" is. I was visiting my Sister who is a social worker, she invited me to sit in on an SW training session. They were showing a tape of family dynamics. Something came up and I said to Sis "That guy on the tape is lying" The presenter stopped teh tape leaned forward and said "Why do you say that?" (Errr GULP! Me and my.....) Turns out I was as fast if not faster than all the trained social workers in the room at spotting someone lying or fudging and could "see" the abnormal dynamic but I could not explain it nor could I say what to do about it.

    Turns out this is not uncommon. Nurses have very good bulldust barometers they just can't explain why. It could be the "red flags" ( 1= coincidence, 2= slight suspicion, 3= suspicious >4 = I will watch you and weigh EVERYTHING) or it could be that we are recieving incongruous messages between subliminal clues and actuality. (When they limp do the muscles react in a way that confirms there is underlying pain? Does the face look drawn? What are the muslces around the eyes doing?)

    Attention all Nurse Researches! - good research material here - just how do nurses know if someone is in pain?
    Originally posted by Rapheal
    This would never happen because the hospital would not like the publicity and hippa , and probally a dozen other reasons-but wouldn't it be great if:

    ER calls the police to report the theft of valium and gives the name of the patient-suspect. They go to her home or stop her while driving and find the valium and she is arrested for theft and possession of drugs.

    But alas, not in this lifetime.
    You can call the cops because a crime has been committed. I have done it before and unfortunately will probably do it again!
    My favorite from one of our "frequent flyers". Brought in to ED in wheelchair with "terrible pain" in his back. "Could not even stand" to get out of wc into ED cart. ED doc went in to room to examine and informed patient he needed to get on bed, pt refused so doc refused any Tx. Pt got mad, got up and walked out of the ED with no limp or "agony".
  6. by   canoehead
    Ha! Excellent bulldust detector there, RN!
  7. by   debi87021
    It seems to me that all ED's get those frequent flyers, and seekers. I agree that nurses seem to have this nack for busting the liars. My seekers are usually allergic to toradol, motrin, and tylenol. I had a women once, in again for migraine, 3rd time in one day, anyway, doc told her she would get demerol shot, ordered toradol, Patient left without any allergic symptoms and no pain 10 minutes after the IM toradol. Two days later she was sent into rehab. (she was hospital employee).
    Also, i haven't noticed a nurse yet that refused care to a patient in need of pain control. We always give them something, just not always narc's, and sometimes i think it is for the best to try other methods before narc's. I know what pain is too, after 2 major abd surgeries, i know all to well. But i found it was easier to get non narcotics, and i felt better, then later the doc would be all too happy to give the narcs if non narcs didn't help. just my opinion.
  8. by   Uptoherern
    What about this situation....one of our ER doc's will tell pt.s that he suspects of drug-seeking that he will give them a pain shot. He then tells the nurse to draw up a dose of "nackle", spelled NaCl-.....wink, wink, nudge, nudge. It is, of course, just normal saline. I don/t feel real comfortable doing this. What do I say if someone should ask what exactly is it? Alot of drug seekers want to know exactly what they are getting ("demerol?, how many miligrams is it? Did he give me Phenergan with it too?" Has anyone else dealt with something like this?
  9. by   caroladybelle
    Tell MD to give it himself - not my job to fudge.
  10. by   prmenrs
    I think that is considered illegal and unethical. I have the greatest respect for the BS meter, but I don't think you should lie to the pts. And don't forget the placebo effect--even sugar pills DO work sometimes if the pt. thinks it will.

  11. by   gwenith
    It is considered illegal to give placebos over here. I do not know if it enshrined in statute or if it is just considered fraud. I would tell hime that if he wants to decieve a patient he can DIY.

    I agree with PRMENRS the placebo effect works well but you Can use it on "real" meds. I give them panadol and talk about establishing a "background level of pain relief" or creating a "synergistic effect" with existing medications. Trick is you have to say as if you believe it and this has just enough credibility to be believable (it's not that it is untrue it is just that it is not as effective as you are about to convince them). A lot of frequent flyers crave the attentions as much as the meds and this sort of approach keeps them very happy while convincing them that you have thier best interests at heart.
  12. by   AZEMS
    ER-ED "everyone requesting every drug"

    I'm from phoenix also and its horrible out her. I see mom-daughter combination seekers in the ER every three days.
    my only response document and destroy. Sign Rx with phone #'s instead of DEA #'s verify the pts. RX history with pharamacy. Refer to pain mgt. with only 2-3 day supply of pain meds.
    Inform pts with pcp's thet will be called about there "problem" event. Tell frequent non-urgent flyers without obvious disfunction
    long wait related to frequent problem and poor follow-up place them in lower priorty levels and inform your chrg nurse. get them there w/c to help get them out of a car then place them in a seat and tell me you need it for the next pt to be assisted its the only w/c for transport.
    only through our critical thinking and appropriate actions and documentation could we defend, diminsh, and destroy seeking behaviors
  13. by   AngelGirl
    I agree with AZEMS that drug seeking behaviour should be addressed, using a "team" approach.

    The abuser returns to the ER lottery, night after night, hoping to score the BIG one, if, perchance, his/her favorite health care provider is working. This provider tends to ignore the limits set by previous providers and simply opens the candy drawer to give out any med the pt. wants.

    Until providers use a team approach and give out ONE, only ONE Motrin, then dc to home, the abusers will continue to plague our ERs.