pain in the ed

[MAGIK GIRL]

i am wondering if a percocet or an oxycontin drive thru right in the waiting room would be the answer. then perhaps, we would have the time to give quality care to our patients who are really sick.

our er uses the pixis and computerized mar's. the doc orders a drug, you have to wait, wait, wait, and then go to the pixis, get a witness for a waste (if you don't need all of the pre measured dose), and then give the pain patient his dose. never mind the fact that on the way to the pixis you have 6 other things that suddenly need to be done and that pain patient has sent each of his 6 visitors individually at 5 minuet intervals to complain that the 2 hour er stay is rediculous and that he missed his dinner and wants you to fix him something to eat.

by the time you get to the patient, the award winning draumatic preformance is simply breath taking!

now i know that some pain is true. but if i have a kidney stone, an acute appendix, labor pains, or chest pain, the er nurse shouldn't have to come out to the smoking area, tell me to put out my cigarrette, put down my big mac and accompany her to a room where my vs are 120/80 - 70 - 16!

thanks for allowing a "newbw" to vent!

[erjulie]

:) and that's exactly what i mean with "there but for the grace of god, go I" people have pain, whether real or really real, it's all the same to them I am lucky not to be in pain, addicted, drunk, or homeless.

[MAGIK GIRL]

Originally posted by stressednurse

How about really really good staffing and lots of social workers ..............then no need to chat about it until the next fix is needed.

OK my venting finished.

WOW!!

[Terryw]

I agree, there but for the grace of God go I, or my family. However, I have a strong feeling about enabling negative behaviors. People do what they do because they can, and it works. Our ED only sees 25K pts /yr so we have the luxury of doing some police-ing. We, and some of the smaller ED's around us have a "special needs" list. So far that seems to be flying around HIPPA and our MD's are willing to call one another with problem pts. We also document the Rx's given to all pts in our computerized ED log, that gives us a quick way to spot "seekers".

There are no easy answers, but I'm not willing to give up and roll over, (that is what the seekers are counting on) just because the problem seems overwhelming.

[hogan4736, BSN, RN]

Originally posted by teeituptom

Just give them what they want, its easier than arguing with them. And your not going to cure or alter their problems in the ER, the best that might happen is the go to another ER, while theirs cone to us.

No way:o

Origianlly posted by Terryw

...However, I have a strong feeling about enabling negative behaviors. People do what they do because they can, and it works....There are no easy answers, but I'm not willing to give up and roll over, (that is what the seekers are counting on) just because the problem seems overwhelming.

Ahh, yes

It seems teeituptom is doing a lot of "rolling over"

Sean

[teeituptom, BSN, RN]

Well after your department gets put through a couple of spot pain audits by the health department.

After a few politicians call your administrator to find out why you are not meeting someones "PAIN"

After going rounds with JACHO over how well your documenting pain needs of the populace.. And why some patients were denied.

After dealing with some lawyers over why their clients were denied pain meds or why you had a pharmacy refuse to fill their prescription because the patient altered it and the police were involved.

Yes I would have fought it in the old days amd I did. But you are fighting adainst a stacked deck. Even though you win, you still have to jump through all the hoops put up my politicians, beurocrats, and shyster attorneys.

Then yes I choose to roll over and over and over. Its not worth my time, my frustration, my gray hair.

I will leave it to all you young pups to go joustng after windmills. Its your turn to seek out the dragons and remember there are even more hurdles in your way now than ever before.

Been there done that

I will focus on things more important, like honest patient care.

Doo wah ditty

[hogan4736, BSN, RN]

But Tom, you equate rolling over w/ honest patient care. Is it "honest" to show a lack of interest in someone's potential recovery, or ignoring that the patient may be at his third ER tonight, as he is "stocking up" for the holidays (they are stressful you know), and the "candyman" came through each time (he might even be driving himself if we're lucky)...

We could go on and on. But I won't be a (quiet) conduit for a doc and his team of nurses who just want to be "Customer service agents" (I've heard a doc call himself this before )

I will use my (objective) nursing judgement (and objective and subjective patient cues) to help adequately assess whether I believe my patient is in pain.

And if a "turkey file" might help identify seekers, then I'm for it.

If a guy that came in 3 months ago, and was CAUGHT (by security and the doc, WITH THE DOC'S PEN, after she asked for said pen IN THE EXAM ROOM) forging a script, comes to my ER today, I'll be damned if I give him narcs, PERIOD!!

sean

[ERKev]

Originally posted by teeituptom

I will leave it to all you young pups to go joustng after windmills. Its your turn to seek out the dragons and remember there are even more hurdles in your way now than ever before.

Been there done that

I will focus on things more important, like honest patient care.

I can completely relate, teeituptom! Though my hair's not turning gray, it IS falling out!

This is a great forum, though. No where else can we compare notes and frustrations. And, while we seem to differ quite a bit in our potential solutions, it is obvious to me that you are all some fine, compassionate and caring nurses.

May you all have great blessings and a gentle wind at your back...

ERKev

[Terryw]

Well, teeituptom, I been there and doing it for 30 years and have more than my share of gray hair too, but I happen to think that honest patient care is not enabling addiction. If we're going to give up on these people, then we might just as well give them a gun.

[teeituptom, BSN, RN]

Terry if you want to consider it giving them a gun , then go ahead and think that. But I save my energy for the battles I can win.

What can you do with them

Get a psych consult, no, unless they want it.

Call the police, no, violates HIPPA

Refuse to treat their alledged pain, and sit down and consel them that yes they have a drug problem. No, you lose there too.

They c/o to administration

They c/o to the Mayor

They c/o to anyone who will listen.

Thats if they dont yell and scream at you in the ER for discrimination, predjudice, whatever to hide behind the fact, that they have a problem.

Refer them to a 12 step program,,,, " Oh No I dont have a problem with drugs" You just dont want to treat me.

Unfortunately, most ERs arent equipped to or capable to do the kind of counseling neccesary to deal with these kinds of patients. ER docs are stretched enough where for them its also easier to give in to the frequent ER drug abuser. Time for it isnt available when the charts are stacked 10 and 20 back waiting on MDs to see them. And the current laws dont give you any powers to help them. The deck is stacked against you anyway you look at it.

[hogan4736, BSN, RN]

Originally posted by teeituptom

...Call the police, no, violates HIPPA...

I can't believe this...If I have a patient doing anything illegal, WE WILL CALL!

And we have, just last month...A patient purposely threw hot coffee at a dietary employee. The police happily came out and filed a report...

HIPAA will not scare me from doing THE RIGHT THING!!!

sean

[Terryw]

Providing false information to obtain a controlled substance is illegal. Yes I do call the police, and yes they are arrested.....and I might say, they don't return. Our state has stricter guidelines than others. They have be have provided false demograchic info to be charged. In some other states they need to only request narcs under false pretenses.

We have a zero violence policy and that includes verbal threats.

If they become disruptive, we call the police and have them escorted from the premesis. When they get ornry with the LEC, they end up in crobar hotel on a disorderly conduct charge. Our administration backs us 100% and initiates action to obtain restraining orders when necessary.

I am sorry that you practice in an area where you obviously lack support from your administration, etc. No wonder you feel defeated. Fighting the seeker battle is one thing, but you are right.....without support.....it's a battle you can't win.

[hogan4736, BSN, RN]

Originally posted by teeituptom

...Get a psych consult, no, unless they want it...

...Refuse to treat their alledged pain, and sit down and consel them that yes they have a drug problem. No, you lose there too.

They c/o to administration

They c/o to the Mayor

They c/o to anyone who will listen.

Thats if they dont yell and scream at you in the ER for discrimination, predjudice, whatever to hide behind the fact, that they have a problem.

We got a psych consult for them even if they didn't want it. They signed contracts, and got nothing if they didn't agree, very simple.

I've answered many complaints to admin (never to the mayor, though) about seekers and non seekers. I answer each one the same. I will do my job as best as I can, and if that includes confronting a patient (politely) on what seems to be dangerous, addictive, behaviors, then so be it!

I am nurse, and am responsible to educate to the best of my ability, and treat w/o prejudice. (If the doc orders it, I will give it quietly). But in triage, I must educate as well. I've never been written up, fired, etc.

I've worked 12 step w/ adolescents, I've worked a chemical dependency unit for those same teens. You have to do some confronting, irrespective on "how many charts are waiting to be seen"

If you can't deal anymore, or just want to ignore, then think about different kinds of nursing...I did.

sean