When patients lie about rides.....

  1. 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"!
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    About TazziRN

    Joined: Apr '03; Posts: 7,569; Likes: 2,298

    56 Comments

  3. by   Pat_Pat RN
    Stuff like this happens to us also. I don't know if it's legal or not, but sometimes we call the police if we know what kind of vehicle they are driving.
    Pat
  4. by   Mr. Grumpy
    My policy is to see the whites of eyes of person that is giving the ride. Of course people do ask to go smoke, sneak out, etc. Those are the ones that I call the po-po and advise of. You can't adult-sit these people. However, you can inform them of their illegal activities and endangerment of others. Most people that have a vehicle will wait for a ride when you remind them that you worry more about the "others" that they could harm. Especially, when you mention children.
  5. by   traumaRUs
    You do what you can do! You document that you told the pt they could not drive for x amount of hours after receiving the narcotic/sedative. However, if they are alert and oriented, it is on them if they don't follow directions. It is important that you document, document, document.

    We had a patient once who drove in with a migraine, received narcotics, was given detailed instructions (verbal and written and everything was documented very well) and did indeed attempt to drive home. As she was negotiating a curvy road on her way home, she went across the median, flipped her vehicle and was killed. No litigation because of excellent documentation.
  6. 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. Or when someone on OxyContin runs a pedestrian over. You get the idea.


    In my state (and this can vary a lot), you the driver are responsible for what you do behind the wheel. That includes responsibility for your state of health. Even the most basic notation in an ER chart would be enough to prevent civil liability here.

    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 state, those with diabetes....). The watchwords today are individual function and individual responsibility.
  7. by   angel337
    document. document. document. there is only so much you can do to ensure that the patient is safe. we deal with this all the time in the ED. if a patient is A&Ox3 and ambulatory with out assistance, i document that and take their word for it if they say they have a ride coming. however, if a person can barely stand up, i make them wait until their ride comes inside the ED and we escort them out in a wheelchair to the vehicle. this is of course once they are alert and awake. people are adults and personally i get tired of taking care of the same intoxicated people week after week and worry about how they are going to make it home. i do what i can to protect the patient and my license, but i don't sweat it.
  8. by   babynurselsa
    Many times I will wait to give the narc UNTIL the designated driver arrives, then I have them also sign the DC paperwork that they are driving the patient home.
  9. by   TazziRN
    I didn't worry about it because it was my pt. It didn't occur to me the coworker hadn't leraned that part yet.
  10. by   rjflyn
    And nothing stops said ride from driving around the parking lot with said patient, dropping them off at their car.

    As far as getting sued, in this day and age anyone can sue you for anything. To actually win is entirely different. Of course to defend oneself from said frivolous lawsuits can be just as financially devistating as lossing one.

    Rj
  11. by   MomNRN
    This happened a couple of weeks ago to me. I advised pt before giving him 2 vicodin that he would need a ride home. When asked who was driving him, he told me his brother had brought him in and was waiting for him.

    As I wheeled him to the door, I once again asked. He stated brother was probably out having a smoke and he would sit and wait for him. Well you know the rest of the story. Triage was keeping an eye on him, but then he slipped out the door.

    I documented the entire story. With computerized documentation on hand, we can look up previous record so if he comes in again, we will be on to his tricks.
  12. by   mmurphy
    I think that it is wonderful that you are so responsible. However, if a patient has been educated and instructed pre medication why he/she should not drive after receiving the medication, and this patient chooses to lie to you by telling you that he/she understands and they have arranged for another person to drive them home, how could you possibly be responsible?

    I would think some very simple documentaiton of instructions and patient response would be more than sufficent.






    Quote from TazziRN
    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"!
  13. by   TazziRN
    We are responsible for the pt as long as he is on our campus. If he is under the influence of anything (even a chemical he ingested before coming to the ER), it is our responsibility to see that he does not leave the campus behind the wheel of a vehicle or on a bike. He can walk, take a cab, take the bus...anything else. If we know he is driving under the influence and we let him, then we are liable if something happens.
  14. by   sjt9721
    I've been fooled once, several years ago...

    This guy was ordered IV meds for his migraine. I asked him to call for a ride and then I'd give the meds. He was cooperative and proceeded to use the "white courtesy phone" to call his wife. We all saw him having a conversation while on the phone...

    He was reassessed, pain was tolerable and was ready for discharge. He wanted to just "lie on the stretcher until my wife gets here". Sure, no problem...

    I turn back around and HE IS GONE! The registration clerk said she saw him go out the door and drive away. :angryfire

    I called his home number and spoke with his wife. She was so thankful I called...since she hadn't heard from him since he went to the ER...

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