Narcotic Administration in ER

xtxrn, ASN, RN · Aug 4, 2011

I am curious what hospitals around the country are doing regarding narcotic administration to patients with no ride home present, no ride home period, or the homeless population. We have to treat a patient's pain, but NSAID's are either not enough, or are flatly refused. I am curious if there are written protocols out there, or if ER nurses are using a unwritten protocol. I feel like I am being squeezed between angry patients, frustrated doctors, and an unhelpful management. Thanks.

One ED I was at made me hang out for 4 hours, then take a cab home. There was no discussion- that's how it was going to be if I wanted to be treated (it wasn't for pain- and actually unneeded- they decided my PVCs were anxiety :uhoh3: :uhoh3: :uhoh3: , and gave me Ativan IV).

A&OxNone, MSN, RN · Aug 4, 2011

We do not give patient's narcotics unless they have a driver, or are being admitted. Zero. We are strict about this, because the way we look at it, even if they are homeless, if they walk into the street and get hit by a car, they can claim we caused it by giving him meds and not making sure he was with a responsible party.

Not sure about the P&P, as I have not actually read it, but we are very strict about it. A cab ride isn't sufficient. Most of our frequent flyers know this and bring a ride with them.

Sanuk · Aug 4, 2011

We have a written policy that no medications which cause the patient to not be able to drive (narcs, benzos, etc) will be given unless there is a ride present. This is mostly with regards to people with non-emergent complaints requiring pain med. If you come in and are obviously going to be admitted we don't withhold pain meds because you're by yourself. We do not hold patients - the ride must be physically present at the time of administration.

~Mi Vida Loca~RN, ASN, RN · Aug 4, 2011

I didn't have a ride once in Urgent Care, I didn't know they were going to give me narcs, when I told them I drove myself they said they couldn't give me a shot of narcs but they could try Toradol. I was in so much pain I didn't care what they tried if it worked. Got a shot of Toradol and about 40 mins later I was pain free. They said if I had to come back again make sure I had a ride, I haven't had to though.

Roy Fokker, BSN, RN · Aug 4, 2011

Since I work nights:

* If a patient drove themself over - no intoxicating meds unless a ride is 'recorded'.

* Pt. somehow manages to scam me and the Doc for intoxicating meds and presents no ride but is discharged - booted outta the ED. If presents a problem - police called.

There are exceptions, absolutely. But exceptions don't make the rule.

Call me callous. I don't care. Drug seeking frequent flyers we see don't exactly endear themselves either with their charming personality and admirable behavior...

cheers,

Esme12, ASN, BSN, RN · Aug 4, 2011

It a huge problem.....especially in the city. It used to be OK to just let them walk....as long as they weren't driving. Well, like everything else....things change.

Patients have to have a ride present before narcotics are administered or we have them for 4 hours. Policies vary depending on where you live and the surrounding demmographic does a lot to dictate policy contents.

rjflyn, ASN, RN · Aug 4, 2011

As a general rule we keep them around for 4 hours like every one else. The actual written policy though in fact states the pt can be discharged when the provider i.e. doctor or mid level who prescribed the med feels the pt is save to be discharged.

That said the OP opened the door where pts say well you are going to treat my pain, well, if we offer Tylenol for example with is in fact pain medicine and the patient refuses. They cant technically say we didnt try to treat their pain, no you just didnt take the prescribed treatment and that in fact is on you, buh buy.

TrafalgarRN · Aug 6, 2011

.......Check next post

TrafalgarRN · Aug 6, 2011

We have implemented a Chronic Pain Protocol since October 2010 so our frequent flyers no longer get narcoctics unless they have an amputated rib. If pain is their chief complain we administer Toradol(if no allergies) and then discharge them to follow up with the pain clinic or primary care provider.If they have another complaint, we address that but no narcotics are ever administered.

When it comes to everyone else, there is no policy since we are always trying to jack up our Member satisfaction scores. We have liberal and generous doctors who will give narcotics 85% of the time without asking how the patient will get home. And trust me i am mean and its hard to convince me that you need a taxi voucher especially when you are young and healthy and can have friends pick you up. At the same time you are rocking that iphone and ipad. We are supposed to make them wait for 6 hrs for narcotics to wear off but if you are younger that 50 and you are walking with steady gait then the ER lobby is going to be your discharge station; can't keep you as part of my census and have to do extra charting . I will never discharge seniors with narcotics without someone to take charge; also i wont send them home by cab. Of course there are some who insist on leaving after narcotics and i will follow them to the parking and woe to you if you enter that car because they will be broadcasting your APB to every cop car in the neighborhood.

Narcotics policies are had to design; some people need pain medicine as a matter of life or death while others can wait till they acquire someone to give them a ride to home.

F.E.R.N., BSN, RN · Aug 17, 2011

I'm also curious about policies regarding monitoring of patients given narcs. We have an area that has no monitors, but where PAs like to give morphine and such (kind of a high-grade fast track route). I'm not comfortable giving mind- or VS-altering meds and then sending to a non-observed area (e.g., the waiting room) while labs cook. Anyone have policies about this?

ZippyGBR, BSN, RN · Aug 23, 2011

oh dear as usual for AN a combination of judgemental Posters and Narcotic panic ....