Frequent Flyers in the ED

huggietoes · Feb 13, 2004

There are no protocols especially if you are a community/county hospital. Even though they wear your patience to the bone, I try to remember that even the drug seeker who is taking your time from the truly ill and is usually rude especially when they do not get what they request has an underlying illness, drug abuse, possibly some sort of psych issue going on and from what I have seen withdrawal apparently makes you feel as though you are dying and you will employ any technique to get your high even crowding a busy ER. I was becoming burnt from just this sort of thing, then I came to the realization, So they come and get their "fix" and go home, they sometimes smell, are rude, most likely abusive and do I give them the number to the nearest rehab facility, You betcha, but I can't stress about it anymore because in the end all it does is raise my blood pressure after all they will be back tomorrow and so will I.

Baltimore Nurse · Feb 13, 2004

We have the same problem where I work, in the winter months it gets worse, when the homeless shelters wont accept them because they are intoxicated and beligerent they come to the ER. Day after day...Night after night [some even come 2,3,4 times within a 24 hour period]. Often the physicians will do a screening in the waiting room so we dont have to see then in the ER if they are medically cleared...but if we are busy [which is all the time] then the physicians dont have time.

As far as the seekers go.. the doctors set limits and counsel the frequent fliers. We redirect them and do not give them narcotics asa afirst resort while asuring that there is no medical emergency. This usually makes them upset because they mostly ask for IV and specific narcotics upon arrival.

We also have seekers who have a real medical disorder. It is difficult to treat these types of patients becuase you can not deny that they are really sick... it is such a misfortune thay use ther illness to feed there addiction.

Trauma Columnist · Feb 13, 2004

I'm an ER RN who just started in new role as ER Case Manager - we deal with care plans and protocols for our frequent customers.

RNin92 · Feb 13, 2004

I'm an ER RN who just started in new role as ER Case Manager - we deal with care plans and protocols for our frequent customers.

our er recently began utilizing a case manager. we thought that one of her roles would be to assist us with care plans for these patients. but there is talk that we cannot do that because these pts don't have pmd and the care plans and cntracts need to be followed by someone.

any input would be appreciated

Trauma Columnist · Feb 16, 2004

We assign these pts to the only clinic in town that is currently taking new patients. In order for them to get narcotics or ANY meds at all - they must see a primary care provider. We (case managers) also try to talk with all the frequent patients (that aren't currently drunk or high that is) and ensure that they are getting follow - up. We are six months into this role at a level one trauma center. Where do you work? Chicago? Also curious as to how you guys are developing this role.

RNin92 · Feb 17, 2004

We assign these pts to the only clinic in town that is currently taking new patients. In order for them to get narcotics or ANY meds at all - they must see a primary care provider. We (case managers) also try to talk with all the frequent patients (that aren't currently drunk or high that is) and ensure that they are getting follow - up. We are six months into this role at a level one trauma center. Where do you work? Chicago? Also curious as to how you guys are developing this role.

We are in McHenry County. Community Hospital of about 200 beds. Our ED is 20 beds-14 ER and 6 minor treatment (fast track).

We have soooooo many pts who are really being mis-treated that it is very frustrating. I responded in another post about some our nurses being asked to give 200 demerol IV for a FF/migraine. It is way out of control.

We have a committee working on trying to contact other hospitals to see if they have protocols in place. Part of our problem is that they are very few docs who will take pts without ins or on public aid in the county. Some of our moms have to bring their kids to a pediatrician 2 counties away.

Any help would be appreciated.

trsnurse · Feb 18, 2004

So...I think everyone has their frequent flyers crowding up the already overcrowded EDs across the country. I was wondering if anyone's ED came up with anything that works!!!
We have our usual drunks, of course. At least we finally got some of our EMS departments to NOT transport them in when they have NO c/o!!! We had one local PD who picked up one of chronics and arrested him with public intoxication. Of course, they didn't want to keep him so they bonded him out on a SIGNATURE bond (this is important now!) Then they called rescue to transport him to us...because he was too drunk to be decisional and let go.
Ok so he's decisional enough to SIGN a signature bond...but not to pass out in the confines of his own bed!!??!! Sorry...no such luck!
Anyway...I digress!
I was thinking really of the seekers. We tried to come up with protocols and contracts and care plans...no go. I really HATE being the best dealer in town.
Anyone with anything that works?

OKAY-Again I swear you must work where I do-No answers for you but when you figure this one out, Please come run our dept.

veetach · Feb 18, 2004

I think we all have the same problem. We used to have a list, but thats not allowed anymore. We have a unique situation because we are sister hospital with the other hospital in the county, SO..... we share the same computer database, it helps out a lot!

Hey if you guys figure something out, let us know too, ok?

RNin92 · Feb 19, 2004

I think we all have the same problem. We used to have a list, but thats not allowed anymore. We have a unique situation because we are sister hospital with the other hospital in the county, SO..... we share the same computer database, it helps out a lot!
Hey if you guys figure something out, let us know too, ok?

Alright...there has to be SOMETHING!!!

It cannot be that I have to be local drug dealer...and give 'em a free lunch!

These people have found a loophole in the system and we have to find a way to close it. I mean, attendings can get into big trouble for prescribing narcs inappropriately to their patients from the DEA...

We are educated NURSES...we must find a way!!!

petiteflower · Feb 19, 2004

Don't know if this is helpful or not---and I am sure that we are alot smaller than some of the hospitals you all work at so we don't have near the number of FF. Our hospital has a 5 time threshold for FF headaches for narc. I wish it was less, but at least it is a start. Once those patients hit that threshold, they are required to see their pcp--no narcs until then. Their pcp is then to submit a written plan of care and what referrals have been made (neurology, etc) if the patient is non compliant then they do not get narcotics. And we have had a couple of them follow up and get some help and rarely do we see them now.

RNin92 · Feb 19, 2004

Don't know if this is helpful or not---and I am sure that we are alot smaller than some of the hospitals you all work at so we don't have near the number of FF. Our hospital has a 5 time threshold for FF headaches for narc. I wish it was less, but at least it is a start. Once those patients hit that threshold, they are required to see their pcp--no narcs until then. Their pcp is then to submit a written plan of care and what referrals have been made (neurology, etc) if the patient is non compliant then they do not get narcotics. And we have had a couple of them follow up and get some help and rarely do we see them now.

What happens if they don't f/u with a pcp? Do you refuse to treat them?

How did you get ALL of your docs onboard?

Sounds like you may be on to something.