No pain meds in ER??

DWelly14 · Apr 12, 2016

This scares me ... my husband was just recently in the ER with kidney stones. Listening to him talk, all my nursing instincts were telling me that he sounded like a drug seeker (they gave him toradol and he immediate demanded something more because it didn't work, was constantly saying he was still in pain, etc) but living with him and being married to him, I know that half a norco usually makes him sick to his stomach and that he usually avoids painkillers at all costs. I can't imagine the pain he must have been in and what would have happened if the ER we were at didn't have the meds he needed to get him comfortable. When we initially arrived, his blood pressure was 170/107 all due to pain.

ShaneTeam · Apr 12, 2016

This scares me ... my husband was just recently in the ER with kidney stones. Listening to him talk, all my nursing instincts were telling me that he sounded like a drug seeker (they gave him toradol and he immediate demanded something more because it didn't work, was constantly saying he was still in pain, etc) but living with him and being married to him, I know that half a norco usually makes him sick to his stomach and that he usually avoids painkillers at all costs. I can't imagine the pain he must have been in and what would have happened if the ER we were at didn't have the meds he needed to get him comfortable. When we initially arrived, his blood pressure was 170/107 all due to pain.

I am very sorry to hear that happened to your husband. From what I am understanding now, they are talking about taking opiates from first line of treatment, but will still have them available for the patients who need them, after being assessed if the alternatives won't work. I know something has to be done, but it is still worrisome what is coming next.

emtb2rn, BSN, RN, EMT-B · Apr 12, 2016

ED patients don't get surveyed

To follow up on anna's response that er pts do in fact get surveyed, hell yeah. Pt d/c'd from the er are whose surveys count. For admitted pts, the er visit is a tiny section that does not count towards the er's discrete score.

Ask your nm if you don't believe me.

betbrennan · Apr 12, 2016

There have been several studies done. Rectal acetaminophen is slow to dissolve, more if bowel is not clear, oral peak levels donot last long enough but the IV dose peak levels are reached faster and stay at peak level longer. Itis a good med for T&A patients, and renal colic patients when used with toradol

needlesmcgeeRN, ASN, RN · Apr 12, 2016

My kind of ER!

TraumaKittyRN · Apr 13, 2016

Having worked in an ER if you are in bad enough shape to need an opiate like morphine there is a really good chance you are going to need to be admitted. There are pretty good pain medications that will give a person relief until they get admitted. Also if a medication is not stocked in an ER it doesn't mean you can't get it if you have to, all it takes is an order and a call to the pharmacy. It may take a little longer but it's still possible to get a hold of it. I think what the idea here is to not have it readily stocked so that overuse is not an option. If it's not readily available many drug seekers will just leave, also a physician will be less likely to order it if it takes 30 minutes to arrive from pharmacy. It's not that they won't be available for those who need it but we are no longer handing it out like candy.

betbrennan · Apr 13, 2016

This subject is something we could post about forever. The posts have been so impressive and informative. I think many nurses wax and wane on our feelings about drug dependence and addiction and what should be done. I see the common thread is multimodal pain management, common sense and empathy for the condition the patient has. Pain management is going to be very chalenging over the next years, we can't over indulge but at the same time we can't all act like the Betty Ford clinic annex either.

Hollybobs · Apr 13, 2016

IV acetaminophen is used in the UK - is it equally expensive there, I wonder?

It is really expensive here. We do use it when clinically appropriate, it can be so useful as PP have said. We are instructed not to use it unless necessary, in order to keep costs down. There are posters up in hospitals to that effect.

I tell the patient who is new to it that I am giving them "tylenol-in-a-drip-which-is-very-different-in-effect-to-the-tablet-and-some-patients-respond-really-well-to-it" asap. It helps to minimise that knee-jerk "tylenol won't touch my pain" response.

Editorial Team / Moderator · Apr 13, 2016

I tell the patient who is new to it that I am giving them "tylenol-in-a-drip-which-is-very-different-in-effect-to-the-tablet-and-some-patients-respond-really-well-to-it" asap. It helps to minimise that knee-jerk "tylenol won't touch my pain" response.

I just refer to it by the brand name, Ofirmev, until it has infused and the patient rates their pain post-infusion. Many are surprised to hear that it is "just" acetaminophen.

Whitmore77 · Jul 1, 2016

The ED is an emergency location for medical care, correct? Come on! The problem isn't primarily with the patients, it's our society, culture, embarrassing access to mental health and addiction recovery programs.

Please, let's not punish the whole population that presents to the ED!!!

This is something that is understood if one has experienced it themselves.

In my experience, I presented with severe nerve pain throughout my external occipital area. 2 walk in clinic visits and on the 2nd one they sent me to the ED where I received a CT scan and MRI, both were benign, sent home with a small rx for percocet. Pain continued following testing and was escalating to severe. No MD apt as it was the weekend. Walk in told me to go to the ED as they could not help me. Presented to said ED. Was accused of being a drug seeker, my head was not physically examined. I was chastised and sent away with another small rx for pain meds. After I left, I had the courage to touch my boiling, sharp head and sure enough eruptions were happening. By late that night I was screaming as waves of feeling like my head was being stabbed was ensuing. I'm sure ya all know by now I had shingles. A THIRD trip to a different ED (I live in a very small area and drove 45min) for a diagnosis, anti viral, shot of toradol, and told to double up on my pain meds and see my pcp for more.

The worst part about all this? I had NEVER BEEN to the ED (at least this one, and last one was during childbirth) AND I had just gotten a job offer from said hospital. Not to mention the HUGE amount of medical bills. I want a refund!!!

I have a lot of empathy for pts in pain. Whether it be emotional or physical. Addiction will happen pills or not. People with addictive tendencies will use whatever they can get their hands on. Simple solution, continue to develop state registries and have them communicate with each other. Let's not let innocent people get accused, under treated and get caught in the crossfire.

CaringGerinurse525 · Jul 1, 2016

I always worry that I'll be labeled a drug seeker in the ED because I get kidney stones frequently. My kidneys are full of them and every once in awhile one will dislodge and cause an enormous amount of pain. I try to tough it out and stay home as long as I can but usually end up in the er. At that point I am vomiting from the pain and have to keep moving d/t the pain. Iv Morphine and Toradol are both effective. I'm an odd one because when I had a stent placed they sent me home with Dilaudid and it didn't do a thing for me. I didn't even feel like I had taken medicine.

They also sent me with Oxycodone 5mg and I had to break it into fours (which is hard with such a tiny pill) but then I was numb from the chest down. Strange how we all metabolize differently!

NurseDiane · Jul 1, 2016

Blaming the heroin epidemic & opioid addiction crisis on physicians that prescribe opioids is just the government's way of punting the issue to someone else so that Washington doesn't have to answer for their miserable rules & guidelines on drug addiction. Threatening physicians who write prescriptions for opioids instead of stopping the entry of heroin into the country & expanding drug rehab services to be paid for with the medical insurance we are all required to have makes it appear to the masses that they are doing something about the "addiction epidemic", when in reality they are doing ABSOLUTELY NOTHING. If they dump the problem into the laps of physicians, they don't have to deal with any of it. Where is the personal accountability of people that are addicted to those opioids? I do not feel that it is a physician's job to have to look up a patient's prescription pain med history, nor is it their responsibility to make decisions about how much pain somebody is really in. A physician's job is to treat a patient's pain, is it not? Do many conditions not require opioid pain management? Yes. However, are there conditions that mandate opioid treatment ? Yes. Putting handcuffs on physicians & putting limitations on what they are allowed to do, by people that do not have the first idea about pain management is equivalent to putting someone in the cockpit of a plane that has no idea how to fly it. Giving someone a shot of morphine or a percocet in the ER is not going create a drug addict. It will help the patients with legitimate pain. And the other "drug seekers" can be tracked very easily through a hospital's medical record system, if they are frequent flyers. As far as I am concerned, Medicare and the government should pull their noses out of places their noses don't belong. They are turning health care into a total farce. The percentage of people that develop an addiction to opioids after having gotten a prescription for them is minute----0.1% of the number of opioid prescriptions in this country get addicted to them. I find it very interesting that with all of the talk of overdoses, addiction, deaths from opioids and the immense amount of blame on prescription opioids, that no one has provided actual figures of the number of prescriptions for opioids written in the U.S. in a certain amount of time vs. the number of people that have reported they became addicted to them in the same amount of time. Sure---there are people on the evening news talking about how they received a prescription for percocet or vicodin for some routine surgery & got addicted to them and then started doing heroin-----but how many of those are REALLY out there? Pain meds have been around for DECADES. How long has vicodin and/or percocet been around? Morphine? I worked in the ER in the early 90's and do not recall ANY patients coming in with O.D.'s from anything other than heroin. And the hospital I worked in was in Manhattan. Why is that? Why is it that NOW, people are becoming addicted to opioids & then moving on to heroin? What makes it different today than it was 30 years ago? There has to be a factor, or factors, in this vast difference. I'd love to figure that out because doctors have been prescribing opioids for decades. And as I said, I know many people who have had prescriptions for opioids for post-op pain, spinal stenosis, etc., that filled a prescription for 280 pills and used 40 of them----the rest are sitting in the medicine cabinet in the bottle, unused.

I want to know the exact numbers----the number of opioid prescriptions written in a 12 month period of time, for the past 30 years, and the number of reported addictions, overdoses and deaths from those opioids (not heroin). You are not going to tell me that a person gets addicted to oxycodone or hydrocodone in one month, with normal use. And then that brings up the "normal use" part-----at some point, people have to be accountable for their own actions. Is this just another "power grab" by the folks in Washington in an effort to further control our healthcare system? How about targeting the people that get addicted instead of creating fear in the physicians for controlling pain? I am very suspicious and cynical about everything when it comes to health care. Pharmaceutical companies, insurance companies and other big medical companies control Washington & the decisions that are made by OUR representatives. It wasn't until the advent of the internet that the unreal amount of corruption that goes on in our government was revealed. How, for the love of God, did the government get away with mandating that all Americans have health insurance, whether they could afford it or not? And the Supreme Court upheld it after a lawsuit against Washington challenged the constitutionality of it. I am not going to go into a political rant here, but what's going on goes down a lot deeper than any of us think.