Nurse accuses patient of drug addiction!

[Penelope_Pitstop]

A fellow RN on my floor did something last week that continues to amaze and shock me.

There was a patient admitted with pancreatitis, receiving the usual for that diagnosis: NPO, IVF, Dilaudid and Phenergen. Apparently she was asking for her meds as soon as they were due, if not sooner. Nothing new under the sun for pancreatitis.

Was she drug seeking? I don't know, but I don't think it matters. I know I've never had pancreatitis so I don't suppose to know the agony involved. I imagine it's a painful experience. With those cases, I give the meds if they're ordered, due and there are no contraindications. No problem, right?

Well...

My coworker had the bright idea of printing out information on drug addiction, highlighting parts of it and placing it on the patient's bedside table as she slept.

I most likely don't have to share that the patient was very upset. Oh yeah, did I mention that the patient is a hospice nurse? The patient stated after the incident that if she wanted to abuse drugs, she didn't have to come to the hospital. She had easier access to much better stuff.

I cannot understand how or why anyone could think that this is acceptable!

But ya know what? Nurse Nancy doesn't think she did anything wrong.

I'm going to add that this is the same nurse who told me in report that a patient suffering from a stress-induced flair-up of oral herpes virus "need[ed] an HIV test." Hmm, okay. The patient was septic with S. pneumoniae and intubated for a while. Yeah, I think my body would be stressed too...especially since I have HSV! Does that mean I need an HIV test?

Just so y'all know, management is aware and has spoken to her. Patient relations is also involved.

I just had to see if other nurses were as horrified as I am concerning her behavior.

[kanzi monkey]

Well I have to say That when a patient asks for a specific drug (ie dilaudid is the only thing that will work) it does send up a red flag for me, however I have never outwardly accused a patient of drug seeking, I think the worse are the chronic painers, I believe them that they hurt, but when the Docs think they are "drug seeking" and therefore will not give them narcotics, in essence they are making the day a living ---- for the nurse, I was working in the PACU, had a chronic painer who had a lap choley, he was yelling that he hurt like ------- ----!! and I had small children in the bays next to him, so I asked him to please watch is language d/t the kids, which only enraged him, and I also informed him that I was giving him as much as the Doc ordered, but he was gonna have to try and relax so the medicine would work, well he wasn't having any of that because the MORPHINE that I was giving him wasn't gonna work he needed DILUADID, so after 20mg of mso4, and nonstop -------- from him, I called the Anesth, and said this isn't working he wants dilaudid, well the Doc wasn't gonna give it to him "because he's just a drug addict" so I told the Doc that he was disrupting my PACU, and I asked for versed, which he finally ordered, so as I was drawing up the versed the patient asked what it was and I told him it was stronger than dilaudid, and he would feel better soon, to which he replied "THERE"S NOTHING STRONGER THAN DILAUDID

"Chronic Painers" tend to be in pain, well, chronically. They often take high doses of narcs at home. Post-operatively they require more than their usual daily dose, and increasing it appropriately is a standard of care. If a doctor is ignoring this, or is unaware of this, he/she needs to be told--perhaps by you--that prescribing the same amount, or less of narcs than is usual for the patient is not an option. People in chronic pain also tend to have tried pretty much all there is out there, so they know the names of all the drugs, and which ones they want. Sure, chronic pain and addiction overlap--it's extremely complicated. But for a post-op pt, your business is in treating the pain--and if you can make a referral to social work or addictions services or open a conversation about tolerance and pain management during that hospitalization without completely offending the patient, then you are super-nurse.

"too much narcotic" is entirely subjective--there is no defined lethal dose. Had a pt once taking 70 mg po dilaudid every 2 hours. He'd walk to the nurses station 5 minutes before it was due asking for it. 70. that's right.

Not to be mean, but I can't really tease out quotes from your post HappygoLucky since there are no periods. A little challenging for the reading and comprehension of things...

-Kan

[vamedic4, EMT-P]

"Chronic Painers" tend to be in pain, well, chronically. They often take high doses of narcs at home. Post-operatively they require more than their usual daily dose, and increasing it appropriately is a standard of care. If a doctor is ignoring this, or is unaware of this, he/she needs to be told--perhaps by you--that prescribing the same amount, or less of narcs than is usual for the patient is not an option. People in chronic pain also tend to have tried pretty much all there is out there, so they know the names of all the drugs, and which ones they want. Sure, chronic pain and addiction overlap--it's extremely complicated. But for a post-op pt, your business is in treating the pain--and if you can make a referral to social work or addictions services or open a conversation about tolerance and pain management during that hospitalization without completely offending the patient, then you are super-nurse.

"too much narcotic" is entirely subjective--there is no defined lethal dose. Had a pt once taking 70 mg po dilaudid every 2 hours. He'd walk to the nurses station 5 minutes before it was due asking for it. 70. that's right.

Not to be mean, but I can't really tease out quotes from your post HappygoLucky since there are no periods. A little challenging for the reading and comprehension of things...

-Kan

This is a very well written post. Remember too, that chronic pain patients who take narcs at home don't necessarily have a higher "pain" tolerance, but they do have a higher threshold at which their pain is alleviated by IM or IV meds. They can tolerate much higher doses than those of us who don't require that kind of therapy to stay out of pain.

I hope that nurse gets some retraining...and a good talking to. What she did was certainly not in the best interest of her patient. Let's just hope she's not the one to care for any of our loved ones with her judgmental attitude.

[rngolfer53]

Am I horrified?

H***, yes. :angryfire

This "nurse" needs to find another profession, stat.

Perhaps someone should obtain, highlight, and place a copy of Pain Clinical Manual McCaffery, on this nurse's bedside table. She might learn something.

[Scrubby]

I'd never refuse anyone pain relief. This nurse is way out of line and needs further education. It's not our business to go around ferreting out the genuine from the drug seekers, leave that for the appropriate people.

To be honest I really couldn't care less if I gave a drug seeker pain relief, even if they truly didn't need it. I might get shot down for this but to be honest at least giving the drug will shut them up for a few hours so I can go about doing my work, instead of being pestered for it every 5 minutes.

[medicrn16]

As far as 'asking' for certain drugs...my mom had a kidney stone so big it was plugged up her kidney at the renal pelvis and she had hydronephrosis. They gave Toradol (sp?), 16 mg of MSO4 (she weighs 120 pounds), and all she could do was vomit and cry in pain. They finally gave her just 0.5 mg of Dilaudid and poof! The pain was gone...next time she ever has a kidney (hopefully not!), I will be at her bedside 'asking' for Dilaudid because 'it's the only thing that works'. Perhaps I'm naive, but I appreciate the pt telling me what works and what doesn't, especially if they are in chronic pain. This saves TIME if you can give them the appropriate meds from the start.

You know, this bothers me because the opinions of drug addiction are based on so much misinformation! Many people don't ask for the medications they need because of stigma...because of what THIS nurse did. It's ridiculous. Pacreatitis is horribly painful. Had a pt tell me one time it feels like your insides 'in front' are being pulled out through your spine. I will never forget that description.

[UM Review RN, ASN, RN]

I knew a patient who died from pancreatitis. Haven't had any die in the hospital from an od, though.

[talaxandra]

When I was a very junior RN a patient was discussed in handover - she'd reported severe abdo pain but the investigations to date had been NAD and there were some odd symptoms. She was branded drug seeking, and I'd been allocated to care for her.

I probably would have gone with the judgement of the ACN running handover except - B was the younger sister of a friend from school, had trained in the group below me, and I knew her (though only a little not recently). She didn't strike me as a likely drug seeker (though I know addiction can come in many forms), and she didn't have a history of multiple presentations, let alone multiple presentations with unexplained pain.

When I went in to introduced myself to her I said that I completely understood if she'd rather have someone else, who she didn't know, looking after her, but B said she was very happy to have me caring for her. She told me that she'd followed a nurse out to the main desk and saw her - despite a request for 75mg of pethidine, get a 50mg ampoule out of the safe. B told me she'd had to call the nursing superviser overnight to ensure she got adequate pain relief (as prescribed). And she didn't know that the bizarre dreams she'd been having were a side effect of the temazepam she was being given, because she didn't trust the staff enough to tell them about it.

I gave B adequate pain relief whenever I cared for her. I saw no signs of anything except seeking analgesia for pain. She was diagnosed with retrograde bleeding into her pouch of Douglas, something that didn't show up on the initial investigations. I heard through a friend of her sister's that, following discharge, B was also diagnosed with lupus, which explained her confounding symptoms.

I always wonder if I would have treated B differently if I hadn't known her before I heard handover. Whenever I have a patient with high analgesic demand I think of B, and listen to the patient as well as to the handover.

[BradleyRN]

Well I have to say That when a patient asks for a specific drug (ie dilaudid is the only thing that will work) it does send up a red flag for me

I must say that when i am prescribed PO narcotics, i certainly have a specific preference. Recently, my doc prescribed Lortab 10mg, and i told him that i did not want that and to give me Mepergan instead. He did. I certainly hope that i did not look like a drug seeker. I have been given a few different narcotics in my life, and now i have a preference. If someone with chronic pain received morphine and Dilaudid enough times, then they may realize that Dilaudid works better (without being a drug addict). Thankfully, i have never needed iv drugs, but if i ever did, i am sure i would develop a preference just as i have for PO.

The nurse from the original post is a complete idiot, and her incompetence is embarrassing.

[squeakykitty]

My nursing supervisor suffers from acute attacks of pancreatitis often enough for me to know if this nurse said something to her, we would be talking about attending a funeral. She used to have pain so bad that she would cry like a baby (normally, she was one tough cookie! No one messed with HER!) I'll bet if I showed her this thread, she would get the blood hounds out.

I totally understand where your nursing supervisor is coming from. I've never had pancreatitis, and hope I never do, but I did have an ovarian cyst rupture. If I was ever that nurses patient in the OP with "that attitude"---------TWTJT! (totally worth the jail time)

[cherrybreeze, ADN, RN]

I must say that when i am prescribed PO narcotics, i certainly have a specific preference. Recently, my doc prescribed Lortab 10mg, and i told him that i did not want that and to give me Mepergan instead. He did. I certainly hope that i did not look like a drug seeker. I have been given a few different narcotics in my life, and now i have a preference. If someone with chronic pain received morphine and Dilaudid enough times, then they may realize that Dilaudid works better (without being a drug addict). Thankfully, i have never needed iv drugs, but if i ever did, i am sure i would develop a preference just as i have for PO.

The nurse from the original post is a complete idiot, and her incompetence is embarrassing.

Same for me. I've needed PO narcotics on and off for years for a chronic condition, and I know what works for me better and what does not. Unfortunately, because of this, I know I've been labeled in my own ER (I've read the dictation). It sucks.

My sister has had a couple of surgeries in her life. I know for a fact that she isn't drug seeking. After her hyster, she was given Morphine IV initially, and it did not touch her pain. After some haggling,I got her switched to Dilaudid, which helped immensely. Now, if she IS in the hospital (which again, is pretty rare), she will ask for that based on experience. It doesn't at all make her a drug seeker. It's a shame when someone knowing what works for them works against them.

[squeakykitty]

. It's a shame when someone knowing what works for them works against them.

That truly is a dern shame. The only narcs I've ever had was Tylenol with codeine, but it sure did help with the jaw pain. Because of that, I have an idea about what might help the pain if I break my leg.

[HappyBunnyNurse]

The whole asking for a specific drug is a red flag makes me so mad! If you have been fighting cancer for months or have had sickle cell your whole life then you know what works! Why should you feign ignorance? Why should I spend hours calling to get different meds when the pt could have told me to begin with? When pts ask for specific allergy meds or GI meds we don't jump to such conclusions. To the OP a nurse I worked with once was super hyper about pts with "addictions". She would withhold meds and talk terribly about pts. She was later found passed out in the breakroom. Before passing out she hung chemo on the wrong pt and some of her charting consisted of her writing her name over and over. One of the pts confided to a tech "I think my nurse is on crack" lol. Yes there were missing narcotics and yes she was reported to the BON. I hope she got help but my sympathy for her was tempered by how she had been so accusitory towards pts.