Med Seeking Patients

[RNSuzq1]

Hi All,

I've been at my current hospital for over a year and seems like we're getting more and more "med-seeking pt's" on our med/surg floor. This is a term frequently used on the floor for pt's that have had ever test known to man with no real disease found, so they are usually diagnosed with "chronic pain from unknown origins" and all are frequent visitors. Most are followed by a Pain Clinic, but when the Clinic is closed, they all show up at the hospital for their meds.

We were taught in Nursing School that everyone experiences Pain in different ways and to go by what the pt tells us, not judge their pain on their appearance or demeanor. However, we have this group of frequent visitors, all middle-age to older women that are obviously drug addicted and cause all sorts of problems when they're on the floor.

They insist on knowing what prn meds are ordered, how much, how often, etc.

Most look like someones sweet old Mom or Grandma - very nice to start with (honey this, honey that), but they watch the clock all night and if we don't get them their morphine/dilaudid (whatever) within minutes of them asking for it - they'll hit the call bell every minute - yelling, screaming, swearing until we get them their meds.

We have a lot of terminal/hospice pt's on our floor. We usually have 7 pt's each - a combo of hospice and med/surg pt's. It's really upsetting to be in helping one of my cancer pt's who is "literally" dying in pain and get 10 pages in a row from one of these med seeking folks telling me they're going to "die" if I don't get them their morphine RIGHT NOW!!!

When I go in their rooms, they're usually watching tv, in no obvious pain, but their typical response is - I don't care that you have other pt's, I'm having 10/10 pain (it's always 10/10 pain) and expect you to give me my medicine when I ask for it. As soon as they get the meds, their eyes roll back, they usually say something like - now that's more like it and start slurring. I'm starting to feel like a drug dealer and I don't like it.

One of my Charge Nurses said most of them should be in Mental Health, but they don't have the room, so we get them. I really like this floor, but the verbal abuse we get from these pt's is just too much to handle on a daily basis. My question is - how do I deal with them without losing my cool? Nice, doesn't work - they don't care if you're nice, they want their meds when they want them and don't care if you're busy with other pt's. Any suggestions???

[KnitterMama]

I've worked with a lot of challenging pain patients as well. It is so difficult.

What I have found to be helpful is limit-setting and boundaries. This has been difficult as a new nurse because, sheesh - I barely know where the limits are, sometimes.

First and foremost, people who are infringing on the rights of other patients or caregivers to feel safe in their environment are crossing the line. In this situation, one should not hesitate to seek support, in the form of other nurses, aides, or security PRN. We have to be safe, and we have to keep our patients safe. Any behavior which violates the confidentiality, dignity, or security of another patient (yelling into a room from the hall, walking into the room to demand something of the nurse) is beyond inappropriate. Violating the safety, or feeling of safety, of a staff member is similarly inappropriate. The best case scenario in these situations is anticipating the potential for crossing that line and setting boundaries early. Calm, honest, straight-forward communication is essential. It is also essential that other personnel be aware of the boundaries, particularly nursing assistants. In my facility, on a busy day, it is not uncommon for them to be more on the "front line" in this aspect than myself, because they are the first to answer a bell, or are in the room more frequently. It is not their job to create the boundaries, but we can help ourselves, and our co-workers, by ensuring we are all on the same page.

[sammy75]

SusanNC I totally know where you are coming from. I have had numerous "frequent fliers" who have flat out told me they are just there for their pain meds. Of course these are the same people who are constantly going downstairs to smoke, swap stories w/ other patients, etc. I've even had patients who where directly across the hall from one another, both would go smoke together (of course stopping their IV pump and disconnecting them before going outside) and then when they came back they were in sooo much pain or they were sooo nauseated (sp?) while sitting eating potato chips and just laughing as you walk out of the room. That really p***** me off!!!

[litbitblack, ASN, RN]

I can honestly say sometimes I do get judgemental about these types of pts but what I do when I know someone is timing there pain meds is to just write on their board or tell them when it is next due and I schedule it on my worksheet. If you know they are going to request it you might as be more ready to give it. Then they build the trust that is needed for them to feel comfortable. You also cut down on them coming to find you. I haven't really had anyone come find me for thier pain med. I did have one pt that had a horrible cellulitis and wanted more ms after getting 6 mg. I called the doc for him and he ended up leaving ama to go somewhere else. You can't win them all but at least if you are the advocate for the pt then they will build that trust in their caregiver and it makes their healthcare exp better.