How do you handle the "ones that are out for drugs"

  1. In the ER I have noticed that we have many patients that constantly want pain medicine and refuse to take the PO kind because it "dont work as fast". I am not talking about the patients who are really ill, but the ones who come to the ER and just want "pain meds". I find myself torn because I see the Hospice patients that hardly ask for anything as well as the elderly. I don't understand it.

    How doyou all feel about this and how can you treat the patient without being "aggravated" in your mind?
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    About level1_traumaRN

    Joined: Sep '06; Posts: 29; Likes: 3
    ER RN
    Specialty: Med/Surg, Peds, ICU

    13 Comments

  3. by   scrmblr
    I do get irritated. I see some of these "chronic painers" every stinkin' shift that I work... My husband has helped me with some of my feelings. (he used to be a knuckle dragging er nurse...he is now a hospice nurse:gandalf: I like to call him the "wise one" now )

    It helps me to understand that these people often have REAL pain. It may be chronic and have no cause, but it is REAL TO THEM. (I am NOT talking about the chronic pain in my ass drug seekers-these are a whole different breed) I think people get "stuck" in a "pain cycle" For whatever reason they have saaaay chronic back pain. They put up with it for a long time and then one day they "just can't take it anymore" and they head off to the ER. We give them a warm blanket, narcotics, maybe an xray, narcotics to go home with and they feel better. They have just started on a pain cycle. I think some people get stuck in a negative feedback loop. Some people actually go to the specialist or pmd that we recomend. They change a habit-lose weight, start PT try acupuncture. Whatever- Or they have something that can be helped with surgery. But some people have chronic pain with no known cause. Frustrating for EVERYONE. I just TRY to remember that they are my pt for a brief time (they don't come home with me-thank goodness) I do my best for them, but I am not one who will baby them. I'm not a huggy touchy feely nurse to these pt's. I am professional and offer the best of my care-but I try not to let them get personal or under my skin. I think some people are emotional vampire's and I try to maintain some distance.

    --guess I am a knuckle dragging er nurse--cause they still manage to drive me insane
  4. by   TazziRN
    We will treat the pain they claim to have, and that they undoubtedly do have. But we don't give them a script for 30-60 pills, we give them a small amount to get them through until they can see their PMD. If a person comes in just for a refill of narcs (this happened the other night), they are sent out without a script and told to see their PMD.
  5. by   CritterLover
    [font="comic sans ms"]i acknowledge that the situation is completly out of my hands.

    i didn't tell them to come to the er. they decided that themself.

    i don't order the pain meds -- i only administer them.

    since i only work pt in the er, i realize that the er docs know the ffs better than i do. if they order lortab, rather than dilaudid, for a patient c/o severe abd pain that has had 30 visits in the past 3 months, there must be a reason.

    if the patient tells me that "i don't want pills," i let them know that the doctor has order pills, and that is what i have to give them. i tell them that i will relay their thoughts/concerns to the doctor, but i warn them that i seriously doubt the doctor will give them anything parenteral unless they give the pills a chance.

    if the doc wants to give them something iv/im, fine. i'll give it. if not, i let the patient know and give them the option of taking the pills. the way i look at it, it serioulsy decreases their credibility to refuse to take pain pills when coming in c/o pain. if you are truly hurting, you'll give the pills a shot. they may not work, but you will be willing to try them.

    we have a few new docs in the er where i work, and between us, we've probably been "taken" a few times lately with regards to pain meds. too busy to look up the old chart, there too infrequently (me) or not enough yet (them) to know better. however, i have to agree that it is better to give pain meds to those "seeking" than to let someone who is truly hurting lie there in pain.
  6. by   TazziRN
    Quote from critterlover
    [font="comic sans ms"]i have to agree that it is better to give pain meds to those "seeking" than to let someone who is truly hurting lie there in pain.
    i don't have a problem with medicating a pt while in the er, unless i'm giving them demerol and morphine and stadol and they still tell me that they're in pain until they get the dilaudid they came in for. i do have a problem with sending these same people out with large scripts, because they end up using us as their refill center.
  7. by   jade-athyst
    A very experienced nurse mentor of mine once said "if your'e not a drug addict when you come into the hospital, we won't give you enough to get addicted, anf if you are already an addict, we could never give you enough to make you happy."
    My take on the whole issue is, so what if we get "taken" now and then. It will soon become obvious if they're drug seeking (for example, if they keep coming back without trying to address the pain in other ways). And if they are a true addict, is that one shot of dilaudid going to make them more of an addict? I think it's much more important for us to avoid not treating someone with "real" pain. It's like some people say about the death penalty, it's better to let a few guilty one's off than put one innocent person to death.
    Also, speaking from personal experience, people can have pain that can't be proven by any tests. I have very real chronic pain that doctors can't figure out, but I'm not a drug seeker. I've actually opted not to take narcotics when they were offered because I don't like the way they make me feel, and I wouldn't be able to safely practice as a nurse on them. Yet I have had a doctor dismiss my pain as drug seeking, I suspect because he didn't want to admit that I he couldn't figure out the cause.
  8. by   TazziRN
    Quote from jade-athyst
    if they are a true addict, is that one shot of dilaudid going to make them more of an addict? I think it's much more important for us to avoid not treating someone with "real" pain.
    No, of course not, but it does make us their "supplier" if we add to it with a script. I don't even mind medicating someone who does try other things to control the pain but is having breakthrough, because they're trying.
  9. by   lovingtheunloved
    One of my instructors, (ER nurse for many years) said she was always more than happy to give Dilaudid to everyone that asked because it cleared out the waiting room really fast.
  10. by   Larry77
    You don't think these people are just using the system to get "drugs" do you? Oh my...LOL

    I use in my charting, "Pt states 10/10 px to abd, appears comfortable, visiting, laughing with s/o, MD aware of stated px"

    If I'm getting completely fed up with one of these pt's my coworkers are very good at taking care of them for me so I don't say something I'll regret and get myself in trouble, we all watch eachother's back this way.
  11. by   tencat
    Pet peeve of mine, though I don't work ER. Drug addict or not, they've got pain. I just had a drug addict on a Med Surge floor who was UNDER medicated because of his lifestyle choice. Wet to dry dressing changes q six hours in six inch long 2 inch deep wound with ONE lortab every three hours. No extras for dressing changes. How is that helping the patient and causing no harm????? I can't fix their drug problem, and honestly don't see how I am going to make it worse by giving adequate relief. JMHO.
  12. by   MedicRN111
    I personally dont order nor prescribe any unless I know it is true pain, and if I have any hint it is not..... they get Tylenol and/or Motrin.
  13. by   Larry77
    Had a cop get mad at me for medicating a pt with PO Dilaudid because I was "feeding his drug habit". I said being a drug addict does not stop someone from being treated. The guy had a displaced humerous fx for Pete's sake!

    My issue comes from the people truly overstating their px. Someone with 10/10 abd px is not visiting and laughing with their family while asking them to go get them a big mac. I try to explain what 10/10 px feels like to no avail.

    Lucky for us our doctors are usually very stingy with their px meds in cases like the above stated and are very good at listening to us nurses regarding our observations. "BTW doc I had to wake room 5 up when I asked their px scale which is still 100/10"
  14. by   fsmtg
    This really does get to be an ethical dilemma that many nurses and physcians must face on a daily basis.

    a qoute I once heard really sums it up. "knowing the difference between wrong and right is easy. They hard part is deciding which wrong is more right."

    Do you try to get this drug seeker help for their addiction? This inevitably leading to a long drawn out confrontation. do you give them what they want, get them out of the over crowded ER and move on to someone who really needs help.

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