I am a primary care NP, working with 2 MDs and 2 other NPs. Recently, I had a 90 years old patient, who has post herpetic neuralgia, had shingles 2 years ago. She has h/o diabetes, dementia, sciatica and hypothyroidism. Pt had a fall a year ago, broke her left hip, hemiarthroplasty done. This patient was on oxycodone 5 mg tid prior to the fall for her sciatica, which was tapered off recently in September. After her shingles, she was started on gabapentin 300 mg hs. Patient came this time to the office with her aide, who is with her for 10 years, complaining of neuralgic pain on the left side of her body, more in lt mid back. Aide insisted that gabapentin is not working, patient needs oxycodone back and the patient's daughter is also insisting for oxycodone. I tried to explain the risks, aide would not listen to me. She threw a storm at me. Patient is demented, has no say. I increased the gabapentin to 300mg bid, lidoderm patch for the left mid back and asked her to follow up in a month to see the change. I called the patient's daughter and explained, which she understood. Later, the office manager told me that this aide was collecting patient's medications from the pharmacy, (reported by the pharmacist), who knows whether the patient was getting oxycodone in the past or the aide was using/abusing it? What would you do here?
