Patient Cheeking Meds!

Nurses Medications

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Hello, I work at a SNF on a floor where we get a lot of IVDAs whom need long term antibiotic therapy. We've been having a lot of patients lately that cheek their narcotic pain meds. One particular patient has been using his tongue to place the med behind his front lower gum and when I ask him to pull out his lip he has refused or clearly takes the pill out of him mouth and puts it under his blanket. There's high suspicion of him shooting it in his picc line from syringes they get from the sharps box (by using tape on spoons to reach them etc. they are very creative). The next nurse had the same problems with him and got an order from the MD to have meds crushed. The next day the patient went to the chief clinical officer and said he was being targeted and they put him meds back to whole with mouth checks. I caught him today doing the gum thing and he refused so the md said if he does it one more time put it back to crushed. I guess my question is what are the proper policies in other places. This facility allows patients to go outside and smoke when their active iv drug users with picc lines and this is supposedly a. On smoking facility. I fear my license may be at risk if a patient ODs or gets a PE (which has already happened once on my time) when nurses aren't supported at times regarding patients Cheeking their meds and the amount of freedom they get.

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

The following discussion thread may be of interest to you since it pertains to the topic of substance abuse in the LTC/SNF setting. Click on the link below if you have time to burn while reading it:

https://allnurses.com/nursing-news/the-opioid-crisis-1068610.html

We see a lot of these type of residents now too.

We've switched them to liquid when possible and crush the meds when we can. If they complain about the taste, I use jelly instead of the pudding or apple sauce. If they refuse to take it, our MDs will d/c it or cut the dosage.

Sad to say, but make sure you have easy access to your narcan. We can't have eyes on them at all time. Our residents are getting younger and we are seeing these issues more and more.

What about a behavior contract? Have you gone that direction?

Specializes in Family Nurse Practitioner.

What a shame administration isn't addressing and supporting a safe policy for what now a days is a very common occurrence. My personal policy as a provider is zero tolerance. If staff tells me someone is suspected of cheeking their meds will be crushed and if they don't like it I will offer to discontinue the medication. Its not only their own risk of OD but also another patient, a visitor, someone's child who happens on a stray tablet on the floor etc.

YeahhhhNO in our system which operates based on the fear of a negative review and society with parents who won't ever tell their children no due to possibly hurting their delicate feelings I'm more than happy to set limits where my patient's lives and my license is concerned.

Specializes in Case mgmt., rehab, (CRRN), LTC & psych.

Moved to the Nursing & Patient Medications forum for more replies.

I spent a summer in a big urban city hospital on a gen surg floor, just for fun. We had a lot of junkies in for BID IV antibiotics for their tricuspid vegies / endocarditis. They would wakey-wakey in the morning, have a nice hot breakfast and their 0800 meds via the central line, then get dressed... and leave. They'd be gone all day, with that nice big handy line, come back around supper time, have the 2000 dose, and go sleepy til morning.

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