narcs at triage

EDValerieRN, ASN, RN · Dec 1, 2005

We have a pain protocol in place,and we can give either tylenol, motrin, or percocet. The problem with percocet is that we have to get the MD or NP to sign an order for it, and most of them are hesitant to do so until after they see the pt.... so really it ends up being a choice between tylenol and motrin.

Usually if they are in significant pain, we can put them through to the fast track doc, who will see them first, and then send them back to the main ED after they are medicated somewhat.

babynurselsa, RN · Dec 1, 2005

Narcs at triage sounds like such a bad idea on SOOOOO many levels.

THey get their narc and LWBS and DRIVE away.

Alightweight may fall out of thier chair. Pts in the WR discussing who got what. "WEll she got Lortab, I want some too and I WANT IT NOW!!!!"

How are you going to get the time to do f/u documentation on a busy night. Reassessment and v/s????

This just makes me shiver to think about all of the problems that are potential.

krissyram14 · Dec 2, 2005

We have to RN's @ triage and 2 techs, so reassesments, and vital are ok, but my concern also is the people who leave after the meds. I guess a contract, and if they break the contract we can call the police, since most of the drug seekers or frequent flyers will prob be elimenated anyway. I know if 2 hospital that do give narcs at triage, but even with tordal we would have to get a chem 8. Thanks for the responses. Krissy

ckh23, BSN, RN · Dec 2, 2005

The next main concern would be safety. What is to stop a patient from getting physical and stealing narcs. Sounds like a bad idea.

Trauma Columnist · Dec 2, 2005

We do tylenol, motrin or if they need something more, they are usually a higher triage category and then either go straight back or are seen at triage, IV placed, labs drawn, etc. I work in level one 65000+ visits/year.

Dixielee, BSN, RN · Dec 2, 2005

Yikes! I have never even considered the possibility of narcs in triage. Like others, I can't imagine what a nightmare that would cause. We give tylenol or motrin for fevers in most places I have worked but that is it. If everyone knew they could get their narcs in triage, there would be a line at the door with their hands held out.

Although I have often thought that an ativan atomizer at the window would be a great idea...."how long do I have to wait??"... one spritz with the atomizer, "how many are in front of me now?"...two spritzes with the atomizer. "I saw 2 people go ahead of me that came in after I did."...three spritzes with the atomizer. "What if I was dying, I guess I would have to wait in this waiting room too, HUH?" four spritzes with the atomizer. "I guess I will just call 911 and come in by ambulance, that will get me back quicker"...no atomizer, hand them the phone and tell them to make the call! "Can you call general hospital across town and ask them how long the wait is?" Hand them the phonebook! "I'm leaving, I am tired of waiting"...can you please sign this form, and by the way, don't let the door hit you on the way out!

Sigh....can you tell I was in triage all night????????????????????????????

NYCRN16 · Dec 2, 2005

IMO, this sounds like a bad idea. People would just get thier Percocet, feel better and then leave before being seen. Not only that, all the drug seekers will be lined up with thier hands out waiting. Another good point that someone wrote in this thread is that it could be dangerous if the seekers know that we keep these meds in triage how do you know they wont try to rob you of them? I am in that booth by myself, someone could attack me and noone would even know.

Tylenol and Motrin are a good idea, people who would benefit from this should get it.

suzanne4, RN · Dec 2, 2005

Would not consider narcs at the triage desk.................simple as that.

There is nothing to guarantee that they will stick around to see a provider, plus if the pain is that bad, they are going to need more than what you can give them there.

Please keep yourself safe and don't even consider them at triage. The police also have better things to do than to go and look for someone that left without being seen.

You are definitely opening a bad can of worms with that.

Noryn · Dec 8, 2005

Dont tell anyone your idea! You can go to the hospital administration and say, "Look I guarantee I can increase our ER visits 10 times!" and this would work.

In all seriousness there are so many issues that the others have commented on. Safety, liability, failure to seek treatment, and even causing harm to the community.

I personally always tried to get someone back immediately who was in severe pain. It also depends on what is going on with them. Severe abdominal pain--you wouldnt want to give them something that may cause further harm and if they needed surgery the surgeon would love to know that you gave them a percocet and glass of water when they came in.

Safety as other nurses have touched on. What will the nursing handbook tell you about narcotics? For the most part to monitor respiration and they shouldnt operate heavy machinery or drive after taking. Some people including older people will become loopy with one Percocet. Even though you have someone monitoring them, it would still be better to have them in the bed.

The doctor also needs to assess them before any major pain medication is given. You dont want the pain medication masking symptoms.

Really Tylenol and Motrin are fine for the most part for minor pain or injuries. When you start adding complex medications such as narcotics which can have major side effects or interactions with medications you are playing with fire, not to mention practicing medicine which your license will not allow you to do.

My other concern is that if they are in severe pain, a Percocet or other oral narcotic in the triage would not be the best way to relieve their pain. IM or IV medication would probably be the best way to go, it would provide faster and more effective relief. I would hate to tell someone in severe pain, well this pill will start to work in probably 30-45 minutes.

Kidrn911 · Dec 15, 2005

The strongest Narc we give in Triage is T#3. I have only given it on rare occasion in triage. If they are in pain that bad, we usually make room for them in the back, but remember I work in a pediatric hospital. So Morphine and pulse isn't do able for use in triage