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

mina123 · Feb 27, 2009

Most of these dilaudid orders are give dilaudid IVP 4mg q 1 hr or maybe q2 hr. This is ridiculous !!! That means in my 12/hr shift i am giving this pt 48mg of dilaudid I just think this is crazy!!!!!!!!!!!!!!!

eriksoln, BSN, RN · Feb 27, 2009

Recently i have been noticing a great amount of IV dilaudid addict patients. Nurses what in your opinion we should do? Giving the pain medication for post-op and other acute pain issues, i understand very well that we have to manage pt's pain. But the frequent flyer to our hospitals just bacause they are addicts in my opinion is encouraging these pt's and making a dilaudid/morphine society out there. Yesterday, i refused to participate in this with one of our MD's and demanded that this particular pt be sent to rehab for narcotic problem. Most of these pt's have pyschological issues to begin with. I refuse to be manipulated with this pt group and support there addiction in name of pain and medicine!!!!!!!!!!!!!!!!!!!

I understand your frustration mina123, I really do. But, looking at it in a different light may help you:

Wisdom given to me by a close friend of the family who lived near us. He was a WW2 vet and I loved listening to his stories. I was moaning about my teacher and how she flipped on me about something and how "unfair" it was and how I was going to tell her "where to go."

He said "There are a lot of times in life where being right is useless."

Then went on to explain after seeing the perplexed look on my face:

"Imagine you are driving, stopped at a light. You sit, wait for it to turn green so you can go. The light turns green, has been green awhile, and it is your turn now to go. But, on your left, you see a car. Some young kid who always runs the lights, speeds all the time. You know he is going to run the light, and if you go, he will hit you. It just makes sense not to go, even though you are right and it is your turn. You would, I hope, decide waiting and just going with the flow is better than pulling out in front of him even though "you are right." What is more important to you, teaching him a lesson to take his turn or staying out of a wheelchair, or even ending up dead."

These patients fall into the same category. We are right, we know we are, they know we are, but to "go with the flow" we must catter to them. Whats more important to you...........keeping your job in this financial crisis or teaching Joe the dilaudid addict that he cant get away with it?

Best thing we can do is, be there, be non-judgemental and supportive if they ever do decide they dont want to live that way. In the mean time, I just give them whatever is ordered as long as it is safe for them (lol, with their tollerence, twice the dose they are getting would be safe) and concentrate on my other pts. I dont let them run me around calling doctors asking for more or anything like that, its not safe to the other patients. But, I dont waste my time letting them get to me either.

rjflyn, ASN, RN · Feb 27, 2009

Lets see one facility I worked required a pain service consult if we gave more than 2mg. Mandated continuous pulse oximetry as well. My current ED I just started at but I am of the opinion that max is only 1mg and the we give something else unless cleared by a second provider.

I really liked the drop off in seekers when most places went demerol free few years back. I really like the ballsy docs that just plain refuse to use it. say I am discharging you on tylenol after all it is pain med and get out, just in not so many words.

eriksoln, BSN, RN · Feb 27, 2009

Lets see one facility I worked required a pain service consult if we gave more than 2mg. Mandated continuous pulse oximetry as well. My current ED I just started at but I am of the opinion that max is only 1mg and the we give something else unless cleared by a second provider.
I really liked the drop off in seekers when most places went demerol free few years back. I really like the ballsy docs that just plain refuse to use it. say I am discharging you on tylenol after all it is pain med and get out, just in not so many words.

LOL.

We had one like that on my M/S unit. I could never figure out why he wanted me to fill out the medreq. form with him on the phone instead of just doing it while he was there. Then I realized, he was giving tylenol #3 to the pt.'s he didnt like and I was left telling them. Had to call security more than once cause of him.

heron, ASN, RN · Feb 27, 2009

Recently i have been noticing a great amount of IV dilaudid addict patients. Nurses what in your opinion we should do? Giving the pain medication for post-op and other acute pain issues, i understand very well that we have to manage pt's pain. But the frequent flyer to our hospitals just bacause they are addicts in my opinion is encouraging these pt's and making a dilaudid/morphine society out there. Yesterday, i refused to participate in this with one of our MD's and demanded that this particular pt be sent to rehab for narcotic problem. Most of these pt's have pyschological issues to begin with. I refuse to be manipulated with this pt group and support there addiction in name of pain and medicine!!!!!!!!!!!!!!!!!!!

I've made my own opinions known in the many threads already existing on this subject. Do a search of the site and you'll see quite a few.

Just a question ... which is the higher priority ... that patients with pain are offered relief or that addicts are prevented from getting high? Does drug addiction automatically remove the right to pain relief?

Margot McCaffrey, a pioneer in pain management, made the observation that if we are serious about addressing pain, then we need to accept the fact that some addicts are going to get high.

It's normal and healthy to resent the heck out of being manipulated ... and active addicts are master manipulators.

IMHO, the best defense is to become as knowledgeable as I can about the management of both acute and chronic pain ( and, yes ... there is a difference in both presentation and in treatment ), and especially in the management of pain in the substance abuser.

heron, ASN, RN · Feb 27, 2009

Most of these dilaudid orders are give dilaudid IVP 4mg q 1 hr or maybe q2 hr. This is ridiculous !!! That means in my 12/hr shift i am giving this pt 48mg of dilaudid I just think this is crazy!!!!!!!!!!!!!!!

Narcotic doses vary widely according to tolerance. If you're doing hourly dosing, the pt needs to be on a pca.

Son Tava · Feb 27, 2009

is that your scope of practice... to diagnose and then prescribe treatment? providers are faced daily with this ethical dilemma. nurses can judge and imagine that they have undertaken the hippocratic oath but that is not their role. argue your point with the providers and then follow their prescribed treatment - even if it abrades your puritan ethos.

eriksoln, BSN, RN · Feb 27, 2009

I've made my own opinions known in the many threads already existing on this subject. Do a search of the site and you'll see quite a few.
Just a question ... which is the higher priority ... that patients with pain are offered relief or that addicts are prevented from getting high? Does drug addiction automatically remove the right to pain relief?
Margot McCaffrey, a pioneer in pain management, made the observation that if we are serious about addressing pain, then we need to accept the fact that some addicts are going to get high.
It's normal and healthy to resent the heck out of being manipulated ... and active addicts are master manipulators.
IMHO, the best defense is to become as knowledgeable as I can about the management of both acute and chronic pain ( and, yes ... there is a difference in both presentation and in treatment ), and especially in the management of pain in the substance abuser.

OMG. My fav. theory instructor ever said it like you too. She did it differently, asked for a show of hands "How many of you can say for certain, that you will be, for your entire career, 100% right when decideing who is an addict and who is in pain?" Of course, no one raised their hand. Made the same point as you.

mina123 · Feb 27, 2009

Sorry eriksoln; I appreciate what you have to say but I strongly disagree with what he had to say regarding sometimes in life being right is useless. Good god if i follow that quote I would lose all self-respect for myself. But regarding what you said being cattering to these pt's and many doc's and nurses do just THAT because its easy-- give them there dilaudid they will shut up for hr and two and the whole process starts all over again. I wonder what they do outside the hospital setting obviously they are doing illegal drugs to support there addiction so in a way we professionals are encouraging these drug dealers to sell more whatever they are selling. Do you see how just giving in to them eventually now or in future can affect us or our childern. I am a non-judgemental nurse and a great one at that but Yes i don't care about my job they can fire me if they want but I will not back down in making pt's and some docs realize that they have this addiction!!!!!!!! I was not worried for all these years but it seems like now more and more people are flying frequently to our hospitals just to get high!!!! Meantime my pt's who are acutely having problems are ignored because i am too busy making my freaking addict pt's HIGH!!! OHHHHHHHHHHHHHHHHHHHHHHHH I AM SO MAD:angryfire

heron, ASN, RN · Feb 27, 2009

The frustration evident in the OP raises a question that I've asked before ... how can nurses who deal with drug-seekers get some support?

I worked for 11 years in a job I loved on a dedicated AIDS unit. In the end, I needed to leave, not because of all the death and dying, but because of the relentless addictive behaviors of my patients ... most of whom were infected due to their drug use.

Dealing with an active substance abuser is one of the hardest, most destructive to the nurse, jobs we can do. Yet, there is no venue similar to al-anon where we can sort out the effect these behaviors have on us.

Any ideas?

eriksoln, BSN, RN · Feb 27, 2009

See, the way I see it is, even though we are right, we will NEVER convince them of it. Its a waste of time.

Its been discussed that addicts will "hit bottom" or "have a moment of clarity" from time to time. Thats what the recovery places call it anyway. If you try to force change on them, you just end up frustrating yourself and making them defensive which, more than anything else (including giving them the prescribed dilaudid) pushes them further into the addiction. When they decide for themselves its time to change, that they dont want to live that way anymore, then you can be there for support (you and the SS worker). If you spend your time wagging a finger at them before they come to this conclusion, when they do decide they want help...........they wont tell you about it for sure. Could end up missing an opportunity.