Narcotics administration

Nurses Medications

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I work on a med-Surg floor where dilaudid is prescribed excessively. Especially to chronic drug seeking pts. We have joked that we think some of the pts are setting an alarm to wake themselves up so the can request more IV medication "when it is due" (actually when the time is up and they can get it again) Anyway, we have confirmed this as fact, and I have a problem administering pain medication to someone who is setting a clock to receive it, not because they are genuinely in pain.

What do you think? How would you handle it? These are frequent fliers and this is a very constant issue!

A friend of mine just lost his license because of another nurse that refused to give pain meds to a drug addict and the mess that ensued after that. They restrained the patient on doc orders and got a ua for a drug screen..krazy the pain med should have just been given

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It's sad to see SSC patients labeled as drug seekers once again. Nurses have no business projecting what their idea of what a person's pain SHOULD be. Valuing a patient report of pain as more valid if the patient is apprehensive about taking meds is ridiculous. It flies in the face of all we've learned about chronic pain and tolerance. The reason that these patients set alarms is because they are aware that their pain will return and want to avoid that.

Patient report of pain is not all that matters. Ask your patient to report a tolerable level of pain and medicate to that. If it's zero, medicate so that your patient will report "zero" when pain is assessed. Patient care is ALL about the patient, after all. Not the nurse's expectations of how the patient should feel...

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Specializes in 1st year Critical Care RN, not CCRN cert.
I work on a med-Surg floor where dilaudid is prescribed excessively. Especially to chronic drug seeking pts. We have joked that we think some of the pts are setting an alarm to wake themselves up so the can request more IV medication "when it is due" (actually when the time is up and they can get it again) Anyway, we have confirmed this as fact, and I have a problem administering pain medication to someone who is setting a clock to receive it, not because they are genuinely in pain.

What do you think? How would you handle it? These are frequent fliers and this is a very constant issue!

Sorry but what difference does it make to you? Are they breathing And alert? If so give the medicine. The doctor ordered it And your judgment of their physiologic condition (I.e. breathing and alert) is your only stop gap. If you think that they are seeking, so what. It's ordered and no contraindication exist for admin.

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What a poor excuse for a nurse..makes me sad to see that there are nurses out there with zero compassion for people with addictions..who do you think got most of them addicted in the first place? You are very judgmental and you are completely wrong about the type of people who suffer from addictions..maybe another round back in school may straighten out your thinking..you should be ashamed of yourself Jory!

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We teach patients to ask for the med before they are in pain, so how can we judge them when they do that?

Judgment aside. If it's ordered and safe I'm giving it. I do not live in that person's body and I would not want to be judged that way.

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Specializes in 1st year Critical Care RN, not CCRN cert.

What bothers me is that we nurses want to call that addiction. What about pseudo addiction, a behavior that mimics addictive behavior because the patient is under treated and needs more Meds but doesn't get them. That was happening to my mother and when I sat with her pain doc and I explained that he became far more understanding. At first it seemed like he was going to straight up bite my head off but he let me carry on and then did some rethinking and wrote for higher doses for her. She is no longer seeking more Meds because she is in a better place for pain and can actively participate in her pt.

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Specializes in Med-Surg.

It is great to get such extensive fees back. It is nice to know this is something other facilities are encountering!

Thanks to everyone who has contributed!

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Just curious...is the cancer patient white and the SSC patient black? Just curious.

Is suspicion of drug seeking ever driven by a patient's race?

Just a reminder...Med-Surg nurses are charged with treating the patient's medical conditions, not addictions. Unless you are working in a drug-treatment facility, you are not equipped or trained to treat the addiction. You must treat an addict's pain like you would any other patient's pain, which is to the point of reasonable relief.

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AGREE. It SUCKS to be in pain. You are pre-occupied with how you are going to get out of pain. I am not a rehab nurse, and I don't want to be, but I do not ever remember being taught , required or expected to diagnose, and then subsequently order treatment for addiction. And really. What is withholding a dose of pain med going to do to treat someone's addiction to pain meds? It's just the same as withholding lunch from an obese person because you don't think they are really hungry at their scheduled meal time. Is my judgement that someone is not in pain worth the risk that I am letting them lie there in pain? I don't want my patient grimacing or groaning or hyperventilating before I give them meds. I want to keep them from getting there, just like I'm not going to wait for someone's scheduled BP meds until their BP is sky high.

I wonder how the difference in attitude relates to having been the patient. I have been in severe pain many times with a flare up of a chronic condition and have been eternally grateful to the nurses who were agressive with pain care.

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Specializes in Med/Surg,Cardiac.

I just doubt that a patient's pain is 9/10 when they are eating chips and chatting on their cell phones. I understand that pain is subjective, but seriously, if your pain is so bad, you'd show it. You wouldn't desire to eat fried foods and text message your friends. Isn't that an assessment? I've charted it before. "Pt reports pain 9/10. Requests medication and a snack. Patient currently watching television and talking on the phone. No guarding noted...." blah blah.

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I understand your area of concern and was once faced with this in my nursing career. Later, I then realized, if these people are drug seeking and "setting a clock" which some of them do, lol. The doctor wrote an order for it, and until the order is discontinued, or the patient is somnolent from too much pain meds, I have to give it....Yes, it can be super annoying. I have found it to be sad actually, that some people depend on a drug to function.

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100% agree with KatePasa. Whether it is safe to administer the medication in question should be the only consideration. On a medsurg unit you are NOT treating addiction, and what purpose does it serve to get into a power struggle with your patient? It makes me very sad how differently mental illness is viewed than physical. You have no place judging any patient or denying PRN medications that have been ordered by a provider because you feel like their addiction is inappropriate or you feel like they are lying to you about pain, etc, etc. If they are opiate dependent, it IS going to take a massive amount of medication to get legitimate pain under control as well.

Just curious if anyone has actually spent time exploring the "frequent flier"'s (hate that term) life history or what led up to their addiction. My patients have been very forthcoming with me when I've asked some basic questions and I have heard some sad, horrifying stories. It may help to realize that these patients are people like everyone else, and most folks don't decide to choose a life of addiction because it seems like a fun idea at the time. In my experience, they have had hard, hard lives and end up substance abusers either self-medicating a mental condition or out of desperation. We nurses are viewed as one of the most compassionate professions...it's time to live up to that reputation and be compassionate to EVERYONE, not just those whose lifestyles we approve of.

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