When patients lie about rides.....

Kinky Slinky RN · Oct 13, 2006

Oh, all the wonderful experience I will receive by signing on to a busy, busy ER here... Can't wait =)

Medic/Nurse, BSN, RN · Oct 13, 2006

I, too, document very, very well.

If concerned, I also have them call a ride (if necessary) and sign (prior to narc administration) that they understand the "No operation of motor vehicle due to potential for impairment x 12 hours....etc" part of the d/c instructions.

I will also keep 'em until I see the ride and then the ride can sign too.

As to the civil liability issue, I know that juries have held bartenders "liable" - so what would make me think that I could be less so. Defending a "lawsuit" that may not have a basis - can sure ruin your day! Oh, there are a LOT of hungry lawyers out there! Practice SAFE!

If I have given you narcotics and you have LIED to me and proceed to operate a motor vehicle - I will call the police. No question. I think it may be my only mitigation defense if ever questioned. "Protecting the patient is one thing (they can hurt themselves) - protecting the public is another!"

Anyway, its gotten to be a pretty big deal with me. I practice the same way, every time. I also will not allow "patients" to drive that I have given medication to that, may not be a narc, but is otherwise very sedating.

:)

OH, I saw an above post that Toradol is not a narcotic, TRUE- but it is a C5 in some areas (news to me too) so... and it can be minimally sedating - so I guess that was it.....

Medic/Nurse, BSN, RN · Oct 13, 2006

Hey there teeituptom, I think you are just too cool, but... I gotta disagree on the HIPAA -

I'm with the TazziRN on this and the OIG -

PUBLIC DANGER = no HIPAA protection.

I give the vehicle, driver description, ID plate, probable direction of travel. Just that they may be impaired and then detail the profound public safety threat!

No names or details of medical problems, medications given - etc.

I have had the po-po show up in the ED and do formal reports before and even then the info is limited!

STAY SAFE!

teeituptom, BSN, RN · Oct 13, 2006

Hey there teeituptom, I think you are just too cool, but... I gotta disagree on the HIPAA -
I'm with the TazziRN on this and the OIG -
PUBLIC DANGER = no HIPAA protection.
I give the vehicle, driver description, ID plate, probable direction of travel. Just that they may be impaired and then detail the profound public safety threat!
No names or details of medical problems, medications given - etc.
I have had the po-po show up in the ED and do formal reports before and even then the info is limited!
STAY SAFE!

Per our ER leaders we aren't allowed to call the police. anymore.

Maybe Im getting old, but I just don't take it personal anymore.

heartICU · Oct 13, 2006

Why is diabetes a reason not to drive? Thanks.

Diabetes itself is not a reason not to drive, but poorly controlled diabetes (i.e. hyper/hypoglycemia) can cause altered mental status...therefore leading to car accidents.

BabyRN2Be · Oct 13, 2006

Toradol is NOT a narc so you should have easily been able to drive yourself home. I don't understand why the nurse would have told you that!

I wast thinking the same thing, Lori. Toradol is non-narcotic and really shouldn't affect a patient's driving (unless they were a bad driver to begin with ). I think this other nurse was really covering herself, or needs to brush up on her pharmacology. Just my opinion. :)

BabyRN2Be · Oct 13, 2006

OH, I saw an above post that Toradol is not a narcotic, TRUE- but it is a C5 in some areas (news to me too) so... and it can be minimally sedating - so I guess that was it.....

Oh, thanks for this bit of information, NREMT. I didn't know that either. I know that it works VERY well for pain. When I was d/c from an ED a while back, I even asked the doc for a prescription for it. I was really baffled when he was reticient to write for it, and when he did, he only wrote for a very limited number (like 8 or something). I have found out since that one can only take it for a week at a time without incurring liver damage (I think).

nursepearl · Oct 13, 2006

This is an inpatient problem as well....

My boyfriend was a pt. at the hospital I work at. I was supposed to give him a ride home before I started my night shift. I told the nurse over the phone that the d/c instructions had to be ready by 3pm. So I get there....they are NOT ready and I told them it would be too late if it was after 4pm (we live 35 miles away from the hospital and I had to be back by 7pm). So long story short he was getting 8mg of morphine IV and they were switching to 9mg dilaudid PR (chronic pancretitis) and they said even if I coudlnt give him a ride he had to leave!!! I said well there is no one else to give him a ride home so the only other way would be for him to drive himself and they said ok!!! I was shocked!

So what ended up happening was he waited in my car til 7am when I got off of work!

:nono:

erdaynurse · Oct 16, 2006

I will usually hold PO and IM medication until the driver arrives and signs for the patient. If the patient has had IV narcotics, I hold all discharge paperwork and prescriptions at the nurse's desk until the driver comes. I also paperclip a note to the chart to that effect in case I am busy or leave the department and someone else discharges (or tries to discharge) the patient. We also have computer documentation and I thoroughly document that patient was cautioned about the narcotic effects of medication, was told no driving for x hours, and patient voiced understanding. I have had patients go to the lobby and offer to pay someone to come sign the driver's signature portion of the paperwork so they can leave, so I make sure that I explain to the driver that, by signing that line, they are taking full responsibilty for delivering the patient home safely - I explain that if they sign and the patient actually drives and harms themselves or someone else, the person who signed as driver may be held legally responsible. I also chart "Driver signature obtained" in my notes.

I also do this for non-narcotic sedating drugs (Phenergan, muscle relaxers, etc.).

And we DO call the police if someone does manage to drive after receiving any narcotic or sedating medication. We do not release diagnosis or personal information, but we are liable if we have medicated the patient and they drive (according to our administration). We have a duty to protect the patient and the public. I wouldn't want the impaired person to hit a car with my kids in it because the nurse felt it wasn't his/her responsibility. I know mistakes happen and people will sneak out no matter what, so we do the best we can do to protect the innocent!!

pagandeva2000, LPN · Oct 18, 2006

I had a pt this morning, rib pain after a play wrestling match a few days ago. He drove himself to the ER and rated his pain at 11/10. I got an order for Vicodin #2, and before I let him have it I had him call for a ride. I spoke to the friend, whose wife is a resident in our LTC unit, he said he would be with her and would await our phone call. I medicated. When he was ready for discharge I was off the unit and a coworker discharged him. He told her that he would just walk down to the LTC and get his friend to take him home. When I came back and found that out I cringed. (Coworker is new to ER, was a PACU nurse.) When I explained how it should have been done, she said "But he said he was going to go over to LTC for his ride home."
About a hour later a man knocks on the ER door. It's the friend wondering how much longer it's going to be because he's ready to go home. My cringe was accompanied by a silent moan. When I explained what had happened he shook his head and said "His truck's not in the parking lot and he never came to get me."
I told the friend to "beat up the pt's other side when you find him"!

This does happen often, and I actually did that as a patient once, so, this is no shock to me.

ThisEDRNRocks · Oct 19, 2006

The patient has to take responsibility for their own actions, unfortunately some of them shouldn't be allowed to :X

I have always been told to document PRIOR to administering the medications that you told them they could not drive. I no longer baby sit patients, they verbalize and sign their understanding of not to drive. It is my duty to notify, if I notify I have not breached my duty therefore I would not be negligent.....could it still go to court....sure....so could the paper cut they get from folding the form they just signed saying not to drive as they drive home.

Just my two cents.

Quickbeam, BSN, RN · Oct 19, 2006

Originally Posted by Quickbeam

I'm a community health nurse with a state DOT and I oversee health and driving issues. I'm the first person the newspapers call when one of the above examples occurs. Or when someone with diabetes crashes.......
I hear all the time "but it wasn't ME that caused the accident, it was my diabetes!!!". Sorry, you own it. Today's laws are much kinder than the ones in the 40's and 50's that prohibited entire classes of people from driving (seizure disorders, in some states, those with diabetes....). The watchwords today are individual function and individual responsibility.

Trudy RN asked:

Why is diabetes a reason not to drive? Thanks.

I'd like to respond. I didn't say people with diabetes should not drive. I did say that when people have accidents related to their diabetes, they usually don't see the connection. They refuse to take personal responsibility.

Unstable diabetes IS a reason not to drive. Diabetes is the number one cause of health related incidents and accidents behind the wheel in my state, dwarfing dementia, seizures and vision issues. I lecture to physician groups all over my state and they are always astonished that people have such problems related to diabetes behind the wheel. I've had endocrinologists say: "I never even thought to discuss driving with my patients". The disconnect is amazing, at least to me.