IV Dilaudid problem patients!!!!!!!!!!!

truern · Feb 27, 2009

While they're my patient I can fix their pain (hopefully), but I can't fix their addiction.

I will not allow my patients to suffer pain needlessly.

superramvette · Feb 27, 2009

This thread kind of ****** me off because what makes you think you know the "addict" from the truly in pain? I say this because I have BEEN THAT PATIENT that your mistakenly think is a drug seeker. I had a motorcycle wreck a couple years back with a compound tib/fib fracture external fixator, tit rod, road rash over 15 percent of my body. I had 5 surgeries over the course of a year including bone graft. I learned from my first two weeks in the hospital that dilaudid was the ONLY med to make me feel no pain. It was the only time I DID NOT HURT. Well after my fixator was off and I was in my boot I had to go back in for my bone graft (months later) my rash had healed and I was in a vader boot. Well sure enough I knew my order of 3 CC every two hours and you bet your ass I was on the call light EVERY TWO HOURS. I know it ****** my nurses off but dilaudid starts to wear off at 1:30 minutes for me. Until you have felt bone pain DO NOT JUDGE. I have never done drugs in my life but I guarantee the nurses thought I was a drug seeker because of my persistance with dilaudid. So please know that you dont know the person OR THE PAIN. It is not your call to make.

EJSRN, BSN, RN · Feb 27, 2009

Although I am aware of these addictions, we must remember that pain is subjective. For all we know these people ARE in excrutiating pain. I'm not willing to make someone suffer because I think or even pretty sure that they're an addict.

LilyBlue · Feb 27, 2009

A patient was found dead at my hospital and blue powder was found in her portacath. She was taking her own meds from home (besides what the nurse was giving her) and crushing them and injecting them into her own portacath. The nurse felt responsible, but I sure didn't see it that way. That woman took her own chances and made her own choices.

I make no judgments on addicts, but I also don't play their games. I've had patients do all kinds of crazy stuff - pour coffee in their urine specimen, put a small pebble in their urine specimen, prick their finger and squeeze blood into urine/stool samples...all to attempt to appear sick and get more drugs. I document objectively and suggest a psych consult. Nothing more I could do even if I wanted to.

I HAVE said to drug addicts who were behaving extremely histrionically, "You dont have to put on a show or exaggerate anything to get meds out of me. If you have orders for the meds, you will get the meds as they are ordered." I prefer to have a drama free shift - I have seen firsthand what happens when nurses attempt to play addict counselor - they end up with patients wailing, purposefully falling on the floor, etc...just creating a bunch of needless problems for themselves.

If they were an addict when they came in, it is not possible for me to make them not be an addict when they leave.

LilyBlue · Feb 27, 2009

This thread kind of ****** me off because what makes you think you know the "addict" from the truly in pain? I say this because I have BEEN THAT PATIENT that your mistakenly think is a drug seeker. I had a motorcycle wreck a couple years back with a compound tib/fib fracture external fixator, tit rod, road rash over 15 percent of my body. I had 5 surgeries over the course of a year including bone graft. I learned from my first two weeks in the hospital that dilaudid was the ONLY med to make me feel no pain. It was the only time I DID NOT HURT. Well after my fixator was off and I was in my boot I had to go back in for my bone graft (months later) my rash had healed and I was in a vader boot. Well sure enough I knew my order of 3 CC every two hours and you bet your ass I was on the call light EVERY TWO HOURS. I know it ****** my nurses off but dilaudid starts to wear off at 1:30 minutes for me. Until you have felt bone pain DO NOT JUDGE. I have never done drugs in my life but I guarantee the nurses thought I was a drug seeker because of my persistance with dilaudid. So please know that you dont know the person OR THE PAIN. It is not your call to make.

Well, but, if you live in a small town, and have lived their all your life, it's very possible you DO know the person and have even socially witnessed the patient taking drugs. That's why I just stay out of it, I let the doc know if the patient still complains of pain, I give the meds as ordered, and I try my best not to play into the manipulative tactics like playing nurses against each other, etc that goes with the territory.

inland18mempire · Feb 27, 2009

pain in subjective and it is what the patient says it is. if they say they're in pain, then i must address it. i have to put aside any personal feelings that i may have about a pt's true intent for IV pain medication because it's not my place. there ARE frequent flyers out there, but there are also people out there with chronic pain who are labeled as frequent flyers. there's no concrete way to tell who's telling the truth and who is not.

LilyBlue · Feb 27, 2009

What sucks so much is that 3/4 of drug addicts, even if they are not in physical pain, are in EMOTIONAL pain and that's why they are using, to self medicate. We do such a **** poor job of addressing emotional and psychological pain in this country (can't speak about other countries) - is it any wonder we have tons of addicts? Nevermind the fact that many doctors would rather prescribe narcotics than take the time to get to the root of the patient's complaint.

hereigoagain · Feb 27, 2009

I worked in a very well respected ER and I had to push a lot of Dilaudid. I did not like it then and I do not like it now. I don't like this drug and I do not like this idea, to give liberally to everybody, only so we can have "peace" and the patients moved out of the ER, out of sight... In the lunch room, I was constantly made fun of, that I am the one that wants to help "everybody"...so the addicts are not even considered people anymore. I spent a lot of time with the patients that I considered addicted and I advocated for mental help (I am a professional and I am trained to recognize abuse and I am not shy to intervene). I think that in two cases out of dozens I tried so hard to help, I maybe hit home, a former pharmacist and a young lady probably went on to get help. {I gave so many mixed meds to that lady pharmacist, that I was thinking, "my G-d, you can kill a horse with those", but it didn't do ANYTHING to her...I had a very strong conversation with her and her brother and both of them were crying and they thanked me, the lady said that nobody was ever honest to her about her drug problem and the brother said that nobody ever even started a conversation about that...EVER...so they both decided that they would work together to get her professional help. I was crying too, but in my heart, I have a family member that is wasting his life in drugs, so I know the helpless pain to watch someone waste away their potential with meds abuse, that's why I don't want to just turn a blind eye to situations like this} Risking to be very unpopular, I did my best to help them. I was called by a doctor "compassionate" that I took as an insult first, he also added "we need people like you, too"...like I was some kind of weirdo being compassionate. But I know he meant good. I will not stop being honest and caring. I want to be able to sleep well at night.

A story related to Dilaudid: A few days ago, I started my shift with a near code. I found a patient overdosed on Dilaudid and Methadone. For some strange reason, the patient was on those two meds in the same time (and a few more and I said to myself when I read the med sheet..."HELL NO!!!", probably miscommunication? (I was not even considering giving her so much stuff and such crazy combination, even if she would have been bright eyed and bushy tailed; I found her like that in the beginning of the shift). She just had a pain pump with Dilaudid implanted the day before, the pump was on and she just got overdosed during the night. She had very deep respiratory depression, still arousable, but had to be commanded to take every breath. We gave Narcan and her respiratory status improved at once, but the withdrawal symptoms kicked in so bad, that she needed to be transferred to ICU. Thank G-d we were all there at the right time, the doctor was very fast and agressive in treatment, the RT was wonderful, the charge nurse, everybody was just wonderful. I checked on the patient later in the day in ICU, she was very grateful to be alive, the pain pump was turned off, she was very scared and depressed, but well for being so near to stop breathing and all. Just another sorry Dilaudid story...and I have so many others...

eriksoln, BSN, RN · Feb 27, 2009

This thread kind of ****** me off because what makes you think you know the "addict" from the truly in pain? I say this because I have BEEN THAT PATIENT that your mistakenly think is a drug seeker. I had a motorcycle wreck a couple years back with a compound tib/fib fracture external fixator, tit rod, road rash over 15 percent of my body. I had 5 surgeries over the course of a year including bone graft. I learned from my first two weeks in the hospital that dilaudid was the ONLY med to make me feel no pain. It was the only time I DID NOT HURT. Well after my fixator was off and I was in my boot I had to go back in for my bone graft (months later) my rash had healed and I was in a vader boot. Well sure enough I knew my order of 3 CC every two hours and you bet your ass I was on the call light EVERY TWO HOURS. I know it ****** my nurses off but dilaudid starts to wear off at 1:30 minutes for me. Until you have felt bone pain DO NOT JUDGE. I have never done drugs in my life but I guarantee the nurses thought I was a drug seeker because of my persistance with dilaudid. So please know that you dont know the person OR THE PAIN. It is not your call to make.

I once had to go to the ER for food poisoning. So, I walk in, report intermitent 10/10 pain (yeah, food poisoning is awfull) that came and went in the abdomen. OMG I was put on a conveyer belt and sent down the line of "drug addict" care from that point on. I didnt tell them I was a nurse.

First the doc. walked into my room and told me he was going to do some tests. I said fine. Had fluids hung and they drew a lot of blood, gave me a cup to save stool in. I did all that, didnt ask for anything. The nurse walked in outta nowhere and was like "We are giving you 2mg dilaudid, but you can have it ONLY every 2 hours until we find something wrong".

I was like..........."OMG, you are not giving me that. Its not that bad of pain. I really dont think that is necessary". I mean, the pain was 10/10, but it came and went. I didnt want it. She stood there sizing me up, I could see her mind working, trying to figure out my agenda. She came back with Toradol. I accepted that. It helped a great deal, but not for long. Turned out I had food poisoning. I didnt ask for anything else the whole time I was there. Ended up being there till the morning...........I think they forgot about me.

I'll never forget though, the "Oh, OK, you have abd. pain, here is your room we will bring you dilaudid every 2 hours" treadmill I was on. Odd.

hereigoagain · Feb 27, 2009

What sucks so much is that 3/4 of drug addicts, even if they are not in physical pain, are in EMOTIONAL pain and that's why they are using, to self medicate. We do such a **** poor job of addressing emotional and psychological pain in this country (can't speak about other countries) - is it any wonder we have tons of addicts? Nevermind the fact that many doctors would rather prescribe narcotics than take the time to get to the root of the patient's complaint.

I totally agree with you, that it is not done enough to address emotional and phychological issues (but I do my part every time, I make time and talk to the patient even if I risk of getting in trouble, because the truth is very hard to handle sometimes). But it is much more done in US than at least one other country I know, lived/raised in and worked as a nurse and trained for four years in med school. In my country of origin, Eastern European, alcoholism is a big problem and at the time when I left the country (1995) there was NO help for that, as far as I know. No mention about it in the nursing school, no mention in the four years of medical school. People were just wasting away, including my own Mother, one of the most beautiful women and humans I ever met...just no help. When you are the family member, it is awkward and sometimes dangerous to start those conversations with the ill person (I would not recommend that to anyone). I was a child and I told my Mother that she drank too much and that worried me that she was going to die and all I got was a good beating (I am talking about physical beating until I could not catch my breath anymore) and many more to come...my Father did not know about the abuse until a few years ago.

So what we can do as nurses is intervene...they will listen and you never know, the time when you tell them might be the time when they realize that there is hope and help...I will not give up on doing it. I learned my mental health resources from dealing with substance abuse with a member in my own family (unfortunatelly) and I am using it. You never know...they might just snap out of it and get help.

LilyBlue · Feb 27, 2009

I think "compassion" can be displayed in many ways - I have occasionally started a convo about addiction with a particularly receptive patient. But it's not "not compassionate: to recognize that you aren't going to cure a heroin user of addiction when he's in with pancreatitis, etc...he's not going to want to get straight from narcotics when he is in pain. Who would? Many docs address the problem (by offering a consult, as addiction is out of scope for many general doctors or surgeons). Many docs DON'T address the problem and I can't blame them...they know that there are multitudes of doctors who will simply write the script once the patient is discharged. And I don't judge those doctors, either. I think the vast majorty of physicians intend to only help their patients, even if they disagree about what "helping" may be.

It is annoying as hell to me to have one patient in one bed whose doctor prescribes narcotics for an infected toenail and have a patient in the next bed whose doctor won't prescribe narcotics for BONE CANCER. But that's how it goes, you can only advocate and be objective.

LilyBlue · Feb 27, 2009

I once had to go to the ER for food poisoning. So, I walk in, report intermitent 10/10 pain (yeah, food poisoning is awfull) that came and went in the abdomen. OMG I was put on a conveyer belt and sent down the line of "drug addict" care from that point on. I didnt tell them I was a nurse.
First the doc. walked into my room and told me he was going to do some tests. I said fine. Had fluids hung and they drew a lot of blood, gave me a cup to save stool in. I did all that, didnt ask for anything. The nurse walked in outta nowhere and was like "We are giving you 2mg dilaudid, but you can have it ONLY every 2 hours until we find something wrong".
I was like..........."OMG, you are not giving me that. Its not that bad of pain. I really dont think that is necessary". I mean, the pain was 10/10, but it came and went. I didnt want it. She stood there sizing me up, I could see her mind working, trying to figure out my agenda. She came back with Toradol. I accepted that. It helped a great deal, but not for long. Turned out I had food poisoning. I didnt ask for anything else the whole time I was there. Ended up being there till the morning...........I think they forgot about me.
I'll never forget though, the "Oh, OK, you have abd. pain, here is your room we will bring you dilaudid every 2 hours" treadmill I was on. Odd.

I agree, and I have been in this situation, too, with a kidney stone...I WANTED Toradol and they wanted to give me Dilaudid. I told them that I was certain it was a kidney stone, as I've had many and passed them at home with nothing but Ibuprofen, and they were all like, "Well, you need Dilaudid for that kind of pain". It would be easy to understand why the general public doesn't understand "PRN" in any capacity. My grandmother, she took a Lortab every 4 hours whether she needed it or not...and sadly, she said that "the doctor told me I had to take this".