Accused of not giving dilaudid

[KMULL002]

I had the misfortune of taking care of a patient last weekend. This patient was a friend of mine that I have not associated with in years. This acquaintance is the type of person who called the cops on a restaurant due to they added the tip into her bill and she didn't want to pay. One of the reasons I stopped hanging out with her was due to she would ALWAYS complain about poor service when we went out to eat; the most memorable experience my birthday was ruined due to her complaining about the service at a restaurant that was fabulous. I met her at a salon and she had started doing my hair and we became acquaintances/friends. She brought me Thanksgiving dinner when I had to work a few years ago. So, she's my patient last weekend. She had her arm bent showing me pictures of the gas station where she fell and broke her arm meanwhile telling me she has a lawyer. I asked her to straighten her arm because the IV was in her AC so she did and I administered 1mg dilaudid. The MD that same day increased the dilaudid dosage from 1mg to 1.5mg but the day shift rn told me in bedside handover report that the patient did not want 1.5 md she only used/wanted 1mg. I asked her if she wanted 1mg or 1.5mg and she said she only wanted 1mg. I gave 1mg dilaudid and then flushed her. She continued telling me her story and the flush syringe fell off bed; patient's husband pointed that out. I found out after the fact that this patient put up a big stink the last time she was admitted for hip surgery posting two nurses names on Facebook saying they were not compassionate etc one of the nurses I was working with that night is one that the patient posted about on FB; she told me she would not ever take care of said patient and because of said patient she switched from full to part time she also told me that another nurse who is a day shift charge quit over that same patient but later came back. I said to myself I wish I had known this before I took this patient. Well back to my point, this patient stated after I gave her the 1mg dilaudid that she didn't feel it. I offered the extra 0.5 mg (which would be 1/2 of the 1mg syringe) and she agreed to take it; I gave it to her. After all this the patient calls my charge nurse to tell her she can't believe I did this to her accusing me of not giving it to her I guess. After I left the room I wasted the 0.5 mg left in the syringe. My question is, how do I prevent someone from accusing me of not giving them their medicine. My thought is that I tell them when I give it to them that I am giving them the 1mg of dilaudid right now. Do I always bring a witness? I wish we could wear cameras. Make a point of verbalizing what I'm doing. Any suggestions? This has bothered me. the patient posted on FB negative things about the hospital and my cohorts about her last stay and the hospital apologized to her. This experience is making me question my career choice. To this day I have thoroughly enjoyed nursing. I LOVE nursing. I love teaching nursing. I love my coworkers and the clients I serve. How do I not allow this experience to taint my satisfaction and love of the field? Can someone's claim be substantiated even if it's false and I lose my license?

Thank you.

P.s. It is my goal to further my education (current BSN want MSN in clinical nurse education) because I love nursing and education so much. I intend on always having hands on nursing care but want to teach too. Just and FYI.

[KMULL002, BSN]

When/where I worked on the floor, Dilaudid came in 2 mg/mL syringe. So wasting was pretty much ALWAYS required (sigh). And wasting required a witness, whose credentials were typed into the Pyxis along with my own.

OP, did anyone SEE you waste that last bit of Dilaudid? I'm not suggesting you didn't but this whole thing may be a crazy uphill battle without a witness.

I ALWAYS get a witness and sometimes I've had to make them look at it but I make them look at it; I've even had to make charge nurses look at it.

[/b]

And...you've learned a lesson here about caring for folks that you know. Don't! You never know what strange dynamics will emerge in that situation.

Good luck, OP!

Thank you. All is well in my world. My manager never said one word to me about this. They know this patient

[KMULL002, BSN]

I had a patient file a formal complaint and threatened legal action because I didn't flush before and after a med (total lie), that I gave his med late (he refused it at the scheduled time), and that I acted "annoyed" at him.

It bothered me for a few days. And I was concerned he might try to escalate it...but so far he is discharged and I haven't heard anything. He complained about every nurse that took care of him. It was a blow to my pride but now I don't care. Next case!

I understand OP's anxiety though. Some patients can get under your skin try as hard as you might to not let them.

Take care of yourself and just do your best with every patient you encounter!

Thank you so much. This is the best advice. I have started meditation to help with anxiety, pain, grief, etc. It has truly helped me. Since it's helped me I thought I'd share.

[KMULL002, BSN]

This a teachable moment. Do not let this person break you and what your goals are in life.

Thank you. I may use it to help/teach others if the opportunity arises.

[KMULL002, BSN]

Your two coworkers sound quite dramatic and frankly thin-skinned. I don't understand how a single challenging patient hospitalized for what must have been for a relatively brief period of time for a hip surgery, could make one nurse quit her job altogether and another switch from full time to part time. That seems like a massive overreaction. It seems both you and your coworkers give this patient way too much power.

YOUR RESPONSE IS NOT SUPPORTIVE BUT I UNDERSTAND IT. MY COWORKERS (CHARGE NURSES) ARE NOT DRAMATIC OR THIN-SKINNED, NEITHER AM I. YOU DID NOT ENCOUNTER THIS PATIENT. THAKS FOR YOUR JUDGMENT.

You've been a member here since 2006. Have you been a nurse for all that time? I don't think you should let one demanding patient question your entire career. Frankly, I'm very surprised if this is first time you've encountered a difficult patient. We deal with all of humanity and are bound to see all sorts of behavior.

[/i][/b]PCT first then RN in 2007. No not the first time I've encountered a difficult patient just the first time I've cared for someone who I knew on a personal basis.[/i][/b]

Back when I did floor nursing, if a specific patient acted out in ways that made me worry that they were capable of lying about the care they received, I'd bring a coworker along as a witness.

As I would have done had I known.

That only happened on a couple of occasions. For the vast majority of patients, I'd just carry on and do my job, and not worry about it. Personally, I never worry about losing my license as long as I do my job conscientiously and according to best practice.

This was a SPECIAL patient it's hard to describe but one response/poster said to look up Borderline personality and it makes a lot of sense now. I am an EXCLLENT nurse who follows policy based on best practice (evidence based practice).

[NuGuyNurse2b]

^ really unnecessary, IMO. You have documentation (pyxis, MAR) that medication was taken, appropriate dose given. It's pt's words against yours - with you having proof of documentation. And a difficult pt like that will have run ins with more than just you, so the evidence against her is more than the complaint she has against you or any other nurse. I guess I work in the ED and I'm not fazed by threats of any kind anymore, but truthfully majority of the people who claim they will file a lawsuit or get your license revoked will find it very difficult on their end to do either.

[LoveMyRNlife]

I realize that you ended up giving 1.5 mg. But, question for the group--if the order is for 1.5 mg PRN, can you just give 1 mg because the pt requests it? Just curious.

At my facility you can give a partial dose of an ordered narcotic. If I do this, I make sure I write a note in the MAR that this is at the patient's request,and then waste immediately.

[_firefly, BSN, RN, EMT-B]

Patients can and will find or create things to complain about / report you for, but most won't. Some try to manipulate you. Set clear boundaries. It is actually not your job to make them happy or cater to them like it is a hotel. It is your job to stay on top of orders and communicate the patients condition. I had a particularly needy patient that complained since I would not cater to her every wish. I had a strong feeling she was going to complain or make things up. I had a CNA in the room for the assessment. My supervisor said next time let the charge nurse handle the continuing anxious calls. You can't allow yourself to get pulled into drama.

[KMULL002, BSN]

^ really unnecessary, IMO. You have documentation (pyxis, MAR) that medication was taken, appropriate dose given. It's pt's words against yours - with you having proof of documentation. And a difficult pt like that will have run ins with more than just you,

She had run ins with almost every other nurse too.

so the evidence against her is more than the complaint she has against you or any other nurse. I guess I work in the ED and I'm not fazed by threats of any kind anymore, but truthfully majority of the people who claim they will file a lawsuit or get your license revoked will find it very difficult on their end to do either.

Thank you. I just know she's litigious because she showed me the information from her lawyer when I went into her room and she was a legal assistant(I guess this is the name).

[KMULL002, BSN]

At my facility you can give a partial dose of an ordered narcotic. If I do this, I make sure I write a note in the MAR that this is at the patient's request,and then waste immediately.

Same here and that's exactly what I did. Thank you.

[nutella, MSN, RN]

she claimed I didn't give her her medication and has her husband was there to claim the same thing. Although it was just Celine flush not the medication. That was my point.

First - make sure that you have an MD order that allows you to give only 1 mg because if 1.5 is ordered and you give only 1 mg that sets you up for trouble. They can order prn mild pain and moderate pain or so. The point is to make sure you do not violate any MD orders.

Secondly - I would probably try not to take her anymore and talk to your charge nurse or manager about it.

Thirdly - if you have to take her - have a witness when you draw it up and administer. It is some hassle but if she cont to say that you did not give her narcotics that will be a problem for you regardless of how crazy or not crazy she is.

When pat make a complaint like that, managers or risk may look into your medication administration practice without you knowing - if you have computer assisted technology etc they can see if you are administering and wasting regularly , the times and so on. This is why it is important to have the correct orders for what you do. Unfortunately, there are nurses who suffer from addiction and who will administer normal saline or such and divert medication, which is why complaints are often taken seriously even if this is not the case or the pat is known for crazy stuff. Talk to your manager, try not to take her anymore and if you have to administer a narcotic to her have a witness for your own protection - this is what I would do.

[vintagemother, BSN, CNA, LVN, RN]

I had a horrible shift one night with 4/5 pts who all had multiple PRN narcotics scheduled Q4. All 4 of them also had manipulative behaviors and were attention seeking. One pts behavior was escalating, so I made sure I had a witness every time I went into his room. Good thing I did. He ended up saying I didn't give him his entire dose of dilaudid. I called my charge RN and also the house supervisor and my manager (who was not present). I also filled out an incident report and documented a ton in the chart.

[nursesunny, ASN, BSN, MSN, LPN, RN]

If I don't have an order for 1mg, I can't give 1mg....