How do you handle the drug seekers?

[itsnowornever]

Ok, disclaimer---37 days left of school for me, but have some nagging questions.

During my ED round we had a female patient who was a drug seeker. Complaining of abdominal pain when no cause was found. Dr did every work up imaginable and was quite patient with her. Problem? She brought her 8 year old daughter into the ED with her and every 10 min her daughter would come to the nursing station and say, "My mom needs her nurse" or "My mom is in pain, can she have medication?" finally, after repeatedly tending to the mom (I wasn't her nurse, but I have kids, so I felt bad for this kid) and escorting the daughter back to the room the daughter came out, put her hands on her hips and said, "My mom is in pain, we have been here for hours and you are doing NOTHING for her"...to make this trip the daughter was nearly run over by paramedics pushing a gurney, a tech pushing a tall cart with linens and nearly tripped a few nurses carrying meds or food. I finally blew a gaskit and sternly explained to the little girl she could NOT come out of that room or she would get hurt by someone pushing something. I took her back to her mom and sternly explained that mom has a call button, she can call her nurse if she needs something but she needed to stop sending her daughter out or her daughter may actually get hit by something or hurt someone else on accident. Mom started to argue with me and say, "I am not sending her out" at this point I turned around and left, found the nurse and told him what happened. Found the DR and told him what happened (he was a cool Dr and was already aware that she was a drug seeker). Mom was a piece of work, let me tell y

In school we are repeatedly told, "pain is what the patients say it is" BUT on the floor, all she got was motrin and she was sent home with motrin. She stated pain was 10/10, but I guess in a students mind motrin doesn't cover 10/10. I'm ok with what was done for the mom (she was there about 10 hours total.)

What do you guys do in this situation? I'm more concerned about the kid. Was I wrong? No one said I was. No one said anything bad about what I did, I"m just curious. And I feel so bad for this little girl. She may grow up thinking medical personnel are horrible people if this is what mom does to her.

[brainkandy87]

I would like to point out that Not One Nurse said that they would withhold MD ordered medication.

Because if your MD has any brains at all, he won't give Dilaudid to an obvious drug seeker. So hopefully you two are on the same page. If an MD orders Dilaudid on a FF who's obviously seeking, yes, withhold it. However, I think it is in very poor judgment to not provide an intervention for someone complaining of pain simply because you think they are seeking. If the MD orders Dilaudid and you think they're seeking, ask him to order something non-narcotic. Simply withholding medication and not providing a different intervention is terrible nursing and below any standard of care.

[Jory, MSN, APRN, CNM]

To me, these situations were never difficult. Here is what you have, broken down:

1. You have a doctor that is responsible for prescribing...that is what they go to school for, and ultimately, it is their call. If you want to withhold because you think they are seeking, you had better be right, because if you are wrong, that is a valid reason for a facility to terminate you and can put your license MORE at risk than administering.

2. As a nurse, your job is to assess and report your suspicions, patient's history, etc.

3. Patient is requesting narcotics and brings her kid in.

Here is how you handle it:

1. Report your findings to the doctor...if he wants to prescribe her enough to put her into the twilight zone, I could care less. Drug seekers are drug seekers BY CHOICE and I have zero sympathy for them. Whether or not they receive the drug has no bearing on me whatsoever. The person who will have to answer for it is him if he's ever investigated for the opiates he writes...not you. As long as you are not giving injections that kills a patient or puts them in a coma, you are clear....but you also cannot be responsible (and neither can the doc) if they are taking other meds and won't tell you.

2. The little girl is another problem...Mom obviously drove there, Mom needs to drive back. As a nurse, you have the right to refuse to give the mother anything that will leave her impaired to drive and if she seems "out of it" while she is in the ER and insists on leaving, I would call social services (Police first)....because she instantly put that child at risk by getting into the car.

To me, it's a no brainer.

[CP2013]

What can you do but ... duct tape the kid onto a chair?

If only they let us bring duct tape in to the department for those days. Pretty sure it'd work better than a posey, 'cause you know duct tape fixes everything!

(Kidding of course, but funny to consider!)

[Melleeboo1]

I haven't started nursing school yet (one month!), but this story sounds very familiar to me. I was that little girl when I was a child. My mother has had addictions to pain medication most of my life, and as a result, I ended up being the parent in the situation. When we would go to the hospital, and I would be the one to try and get "help" for my mom, mostly because I really wanted to go back home and sleep. I could go on, but needless to say, that little girl was being forced to take on concerns and responsibilities far beyond her years

I know your time with patients is limited in the ER, but what can be done for the kids in that situation? Would it have been appropriate to tell her in some way that she doesn't need to be responsible for her mom, that the doctors and nurses were taking care of everything? Could some sort of intervention be done to help the children who are forced into a caretaking role due to their parent's addictions? What can the nurse's role be in that aspect?

This breaks my heart... I was an addict for many years, and while I did some awful things, I never ever involved my child... Wow

[ERnursebyday]

My ER doctors, as well as I, do not feel comfortable giving mind altering pain medications (morphine, dilaudid) to an individual who is taking care of a child in the room. If there is no other person there to care for the child, that is not a responsible thing to do. Also, as stated above, a child should not leave the room without parental supervision. I would never let my child just leave my room. I do encounter many "frequent flyers" who state that they are allergic to NSAIDS, Tylenol, Vicodin and morphine. In my ER, we then ask what is their reaction to the medication? (We are required to document said rxn). I can't tell you how many drug seeking individuals pause and stutter while they are trying to tell me their reactions. Yes pain is subjective, however, we are also intelligent, educated individuals that understand someone laughing on their cell phone is not in 10/10 pain. I find that extremely insulting.

[LeChien, BSN, RN]

I've gone to the ER with abdominal pain and they prescribed me Bentyl which is an antispasmodic, and it worked wonders. Everyone is so quick to give narcotics!

[mrsjonesRN]

The policy at my old facility stated I could not give pain medication to someone if they had a kid in the room with them and they were they only one responsible for the kid at that time.

I actually almost had to call dcs on a woman who was inpatient with a 1 year old and 3 year old in the room. She had a known psych history and know IV drug history. She was changing their diapers and wanted her dilaudid. Then became angry when I told her about the policy. She said the kids had no where to go and she had no family. After her dilaudid was 30 minutes late, she then called her brother and mother to come get her kids so she could have the dilaudid. It was an interesting night to say the least.