Non compliant and frequent flyer patients

TazziRN, RN · Oct 30, 2006

It's just as frustrating for us in the ER, when we try to talk to them about compliance and get "I just don't want to" or something like that. We admit them because we can't, in good conscience, send them out when they are unstable. We admit them, give them a tune up, and wonder how long it will be before they're back and we have to do it all over again.

dona4jc · Oct 30, 2006

We admit them because we can't, in good conscience, send them out when they are unstable. We admit them, give them a tune up, and wonder how long it will be before they're back and we have to do it all over again.

I can understand the unstable patients being admitted. What about those stable? It's really frustrating. I guess because we are in a teaching hospital and the interns are not confident enough to discharge those patients, they second guess themselves or they may just want to pass the buck or something... I don't know :confused:

TazziRN, RN · Oct 30, 2006

We don't admit someone who's stable. If they're stable they go home. They are admitted if they need care they cannot receive at home.

CoffeeRTC, BSN, RN · Oct 30, 2006

:trout: This is not exclusive to acute care. The nursing homes are getting full of these type of pts. Younger and younger. I've had 4 or so like this this last month. They are young, A and O, Independant with ADLs, etc. Mostly they are admitted for IV abtx and wound care. You would have never guessed it. They come and go as they want, missing their IVs and wound care tx once or twice a day, are diabetic and eat what ever when they are out on leave, some have drug hx and are treated for what is probably actual pain (when they are at the nursing home) but somehow can last without pain meds for 10-13 hrs when gone on leave???? Hmmm. something is wrong, huh?

jo272wv · Oct 30, 2006

The ER is not to blame I understand that, If they send a frequent flyer home and the symptoms become worse or overlooked, the ER Docs are liable if something seriously goes wrong. Most of the frequent flyers on my med surg floor are mainly after the effects of IV pain meds and phenergan push. Our hospital is changing IV phenergan to using only PO or Rectal. I see a lot more PO pain meds being ordered if the dx is not gastro. hopefully the drug seekers will get the point that they are not going to get high while being a pt. Most of our Docs and Nurses know who these people are and the pts that are really in pain and need more are advanced as needed. will be intersting to see how this works out over time.

dona4jc · Oct 30, 2006

Most of the frequent flyers on my med surg floor are mainly after the effects of IV pain meds and phenergan push. Our hospital is changing IV phenergan to using only PO or Rectal. I see a lot more PO pain meds being ordered if the dx is not gastro. hopefully the drug seekers will get the point that they are not going to get high while being a pt. Most of our Docs and Nurses know who these people are and the pts that are really in pain and need more are advanced as needed. will be intersting to see how this works out over time.

Yes, we see the trend that the frequent flyers are those who seek IV pain meds.

That patient that I had asked for IV Dilaudid, IV Phenergan and PO Benadryl at the same time. It will be awesome if the MDs/Interns stopped giving them IV pain meds.

GeminiTwinRN, BSN · Oct 30, 2006

Non compliance is one thing, and it is a constant battle in all areas of healthcare to combat this problem.

Seeing someone as drug-seeking and having the attitude that goes with that viewpoint is really disturbing to me. Remember that we are taught that pain is objective, and now is considered to be the 5th vital sign! If someone is in the hospital and the physician prescribes pain relief in WHATEVER form, I fail to see how it is within our scope to withhold meds or reduce the dosage (for example, if the order reads 4-6mg, and the RN gives 4 based on his/her own conception of the patient's pain or lack of pain). The medicine is prescribed, in the amounts it is ordered, with phenergan or without, IV or otherwise.

I have seen this attitude in the clinical setting- usually in older (more experienced) nurses, but now it's obvious that the same attitudes are in younger, less experiences nurses.

Who are we to judge a person's pain, whether they've been in our hospital or unit 1 time or 100 times? The physician's job is to manage care, ours is to implement, using our critical thinking skills yes, but not to the extent that we refuse to carry out the MD's orders. Our attitudes need to be checked at the patient's door, IMO.

Antikigirl, ASN, RN · Oct 30, 2006

We have lately gotten a large population of meth or drug addicts that have figured if they 'voluntarily' enter themselves for suicidal ideation they get a free meal and bed and a servant (Nurses and CNA's) for two days! You can NOT assume they are not suicidal and help...but I do wonder about so many of these lately that after two days say "okay I am not suicial anymore...I want to go home now."

Nothing we can do, have to admit them and can't turn them away according to law. They are really taxing the system of our small community hospital and the other major hospitals are getting the same deal now. We don't have many psych hospitals and placement can take weeks! UHG!!!!!

These patients are demanding most of the time, and we have to take a CNA or RN off the floor for a 1:1! It is crazy!!!!! (no pun intended! LOL!).

I wish they can go to the jail that is two blocks away that has medical services...but they need to have full time RN/MD staff if they are suicidal. And can they pay? Heck no! That is our wonderful tax dollars at work folks, not to mention higher cost of healthcare and higher insurance premiums for you and I!

Frequent flyers, oh we have them! I may work in med surge, but sometimes the MD's just don't know what to do and admit them so they can make room for more urgent cases in the ER. My hubby is a paramedic and believe you me, I hear stories of them nightly!!!! Also, because of new protocols on pain management, you HAVE to treat pain now...(which is awesome in my book, but frequent flyers are the side effect).

I am not sure what we can do except re-examine protocols on people that come to hospitals a certain amount of times over a period of time???

Melina · Oct 30, 2006

I think you meant "subjective" pain, but I totally agree with your point. Pain is constantly undertreated. The goal of pain management is not to keep the patient on the lowest dose of painkillers possible; the goal is to adequately manage the pain so that the patient has improved quality of life.

I was reading an article about "pseudoaddiction", where patients behave like addicts (asking for stronger meds, exaggerated facial expressions, hoarding meds, etc.), because their very real pain is not getting treated adequately. If one is truly concerned, maybe a consult with a pain management specialist could benefit the patient, and, in turn, reduce the pt's need to frequent the hospital.

~Mel'

Non compliance is one thing, and it is a constant battle in all areas of healthcare to combat this problem.
Seeing someone as drug-seeking and having the attitude that goes with that viewpoint is really disturbing to me. Remember that we are taught that pain is objective, and now is considered to be the 5th vital sign! If someone is in the hospital and the physician prescribes pain relief in WHATEVER form, I fail to see how it is within our scope to withhold meds or reduce the dosage (for example, if the order reads 4-6mg, and the RN gives 4 based on his/her own conception of the patient's pain or lack of pain). The medicine is prescribed, in the amounts it is ordered, with phenergan or without, IV or otherwise.
I have seen this attitude in the clinical setting- usually in older (more experienced) nurses, but now it's obvious that the same attitudes are in younger, less experiences nurses.
Who are we to judge a person's pain, whether they've been in our hospital or unit 1 time or 100 times? The physician's job is to manage care, ours is to implement, using our critical thinking skills yes, but not to the extent that we refuse to carry out the MD's orders. Our attitudes need to be checked at the patient's door, IMO.

Moneypitt · Oct 31, 2006

We have a great number of non compliant patients on our floor. We just document everything. Every little non compliant thing they do, they refuse, and that we have informed the doctor so he/she is aware.

I have been on my floor too long because I am actually quite fond of some of our non compliant PITA patients. Some are fond of me too, and will actually take meds, and follow treatment orders when I ask them too. You tend to build trusting relationships with them over time.

KyPinkRN · Nov 1, 2006

Non compliance is one thing, and it is a constant battle in all areas of healthcare to combat this problem.
Seeing someone as drug-seeking and having the attitude that goes with that viewpoint is really disturbing to me. Remember that we are taught that pain is objective, and now is considered to be the 5th vital sign! If someone is in the hospital and the physician prescribes pain relief in WHATEVER form, I fail to see how it is within our scope to withhold meds or reduce the dosage (for example, if the order reads 4-6mg, and the RN gives 4 based on his/her own conception of the patient's pain or lack of pain). The medicine is prescribed, in the amounts it is ordered, with phenergan or without, IV or otherwise.
I have seen this attitude in the clinical setting- usually in older (more experienced) nurses, but now it's obvious that the same attitudes are in younger, less experiences nurses.
Who are we to judge a person's pain, whether they've been in our hospital or unit 1 time or 100 times? The physician's job is to manage care, ours is to implement, using our critical thinking skills yes, but not to the extent that we refuse to carry out the MD's orders. Our attitudes need to be checked at the patient's door, IMO.

actually a person who is dependant on pain meds is more likely to need a higher dose due to a tolerance for that med. I would start at the high end of what the order is... and go from there. I believe everyone who says they have pain, but there is more to it than that. The pain scale itself is confusing and sometimes hard to gauge. Some pts I have seen say there pain in 9/10 one minute and they are sleeping soundly the next minute... so who knows if their 9 is like my 2. It is very subjective... but to deny someone meds also causes psychological distress which increases pain.