ER patient wanting pain Meds

Specialties Emergency

Published

Ok, so I am looking for how other EDs handle this type of situation. So, in the ED where I work. If the MD prescribes the pt a form of narcotic for pain. They have 30 mins from the time the order has been placed to have someone come up to the ED, sit with them, and sign the pts discharge papers. Basically saying they are providing the pt with a safe route home. If the patient is not able to provide a reasonable party then the narcotic isn't given. So, I guess what I am getting at. What are fellow ED nurses hospital protocols for this situation?

Thanks

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Specializes in Education, FP, LNC, Forensics, ED, OB.

Welcome stephfoun10

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Specializes in Emergency.

One of my facilities has a .phrase in Epic for narcotic administration that says patient must agree to have a ride home, etc. I've adopted this at my other facility to protect me as many patients say they have rides, but in fact, do not.

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I think it sounds like a great idea to promote patient safety.

I know I had an incident with my own dentist where the lidocaine they used for a deep cleaning, had more systemic effect on me, and the dental hygienist had to drive me home.

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Specializes in ED.

We don't require a signature of a responsible party but we do have to lay eyes on the person coming to pick the patient up after receiving narcotic pain meds. We don't even prescribe it until the ride is seen IN the patient's room. Not "on their way," not "in the parking lot." The ride must be seen in the department at least.

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My preference is that all of this be addressed during the provider-patient discussion of the patient's needs and appropriate options. This issue becomes a time-waster when there is zero effort to address it before orders are placed.

How does the 30 minute thing work for those who use public transportation or taxi? Is someone watching them board their means of transport? And making sure they don't abandon that the next block up and walk right back their vehicle? For those who have drivers appear, is there any effort to ascertain the fitness of the driver to drive? This whole issue can get goofy pretty fast, and a lot of times places' policies or practices don't fix everything that they think they do...

Sometimes when places think these things ^ through they come back around to simply instructing patients that they may not drive, and leaving it at that.

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Specializes in ED, OR, Oncology.

Did the lidocaine give you an arrhythmia?

I think it sounds like a great idea to promote patient safety.

I know I had an incident with my own dentist where the lidocaine they used for a deep cleaning, had more systemic effect on me, and the dental hygienist had to drive me home.

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Did the lidocaine give you an arrhythmia?

LOL, nope. But I definitely wasn't safe to drive.

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No policy here, we get "dine and dash" all the time.

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Same here.

No policy.

Honestly, it seems like some of the policies are just CYA, and likely not effective cover.

Having somebody else sign the PT's discharge paperwork? I'm no lawyer, but....

Or, putting the nurse in a position of determining that a PT's ride is not more wasted than the PT seems dicey.

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Specializes in ER, ICU.

All the more reason to promote ALTOs (alternative to opioids). Hopefully coming to a state near you... https://allnurses.com/emergency-nursing/colorado-alto-alternative-1150580.html

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Specializes in Emergency Medicine.

Hey, I'm an ED nurse in a level one trauma, stroke and PCI center. As a busy 50-bed ED, often with 20+ people in the lobby, we have a policy that ED patients who are not being admitted cannot receive narcotics without a driver. If they inadvertently receive a narcotic, the patient has to stay for 4 hours to be monitored prior to being released on their own. Under special circumstances, the physician will order us to give the narcotic knowing that the patient doesn't have a ride, but they still have to wait the 4 hour monitoring period.

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