Patients that are not allowed narcotics

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I am a student nurse and just finished a preceptor rotation where I had opportunity to be in the ER with a RN preceptor. There were patients who arrived there with various complaints that were termed "frequent flyers." The ER personel had orders not to give narcodics to those thought to be misusing drugs. I witnessed some, one patient in particular, that left furious stating that she was going to another ER in the region. The PA had the staff and himself call ERs in the area to make aware of this patient's order not to receive narcodics. I felt bad for this patient. I didn't know what to do for the patient. I asked some nurses there, and didn't get any specific answers. Do ERs normally have literature for these patients to read to seek help or counseling, or are any specific groups (like the police) alerted? Any ideas on how these situations are handled?

Is every person who goes to an ER complaining of pain immediately under suspicion? Or is it "just" the "frequent flyers"? And can they not also feel pain, too? I have known plenty of people who get intractable migraines or who have other chronic pain who sometimes feel the need to go the ER because they can get no pain relief from their medication regimen at that time. And yes, some of them are very familiar with pain medications. But that doesn't make them all drug-seekers. I realize there are fine lines being walked here and I realize that certain people come to be known by the ER docs and nurses, but I cringe when people who seek pain medications in the ER are immediately labelled.

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Specializes in EMS, ED, Trauma, CEN, CPEN, TCRN.
Is every person who goes to an ER complaining of pain immediately under suspicion?

Nope, not by me.

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Specializes in Trauma, Teaching.

Documented chronic migraines are a far cry from the vague "abd pain" complaints.

If your abd pain is so severe you must come in for the fourth time this week by amublance (and you've maxed out your lifetime limits of CT radiation for your multiple and all negative workups), and you are prostrate in bed with agony up to the very minute we say you can't/wont/aren't getting narcotics: you suddenly leap to your feet, stomp up and down my hall and try to assault me when I direct you toward the door ...... you will tend to be labeled as a seeker. (And yes, we did offer many and varied non-narcotic pain meds.)

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Specializes in Trauma/ED.

We have "care-plan" patients who do not get narcotics without objective findings. If they come in and have a broken arm from a fall or injuries from a MVC they are not withheld narcs just because of their past behavior.

We rarely use narcotics for migraines (maybe 1/100 patients).

We have a letter that we give patients who exhibit drug-seeking behavior informing them that they will not receive anymore narcs for said problem and some recourses for rehab and f/u clinics.

I think that a good ED nurse can spot REAL pain from across the waiting room and the amount of groaning and screaming is actually inversely related to how much pain someone is experiencing.

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Im a new grad RN in the ED and the first problem i noticed was the amount of people coming in to try to get narcotics! at first i felt bad but once people started swearing at me saying thet wanted their bleeping dilaudid now or they were leaving!! I got over it fast!

When they have reached the point where they drive from ER to ER narcotics shopping the last thing they want to hear is some nurse telling them where they can check into a rehab! (they come from out of state now!)

I do the best i can but you can not make someone get help unless they want to help themselves.

Something needs to be done before these people start to hit up ER's

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No- I've never worked in the ER.. but I imagine if someone was in serious pain and the doc was closed they'd make their way there.

I don't know much about prescription pain meds other than I refused to take them after my csection because they made me feel horrible!

It's really not a problem of people being denied medication for true pain. There are many non-narcotic medications that work beautifully and sometimes better than narcotics - Toradol being one of them. It's when people come in saying that they have some vague abd or back pain who say, "the only medication that helps is one that begins with a "d". And oh yeah, I need 100mg of the one that begins with a 'd', along with some phenergan, but it only works when you push it really fast. Here, let me help you, here's the port (the one closest to the IV site)." When one gets that specific, it shows that they've had a lot of experience with narcotic medication. When the doc doesn't order the meds wanted, the patient may become violent, stopping their pain act and assaulting the messenger, mostly, the nurse, who's probably in agreement with the doc that the patient doesn't want pain relief... rather, the "high" received from the narcotic. This is indicative that the probability of a substance abuse problem is rather high.

These people will often state that their pain is not relieved despite several doses, saying that they are in 10/10 pain after being woken from a sound sleep while their respiration is lower than 6. I don't think that the average person who won't take a Tylenol unless they have a fever of 105F has to worry that they won't receive pain meds after an MVA. With these types of people, often they don't even show up in the hospital system because they haven't been to the ED, and their names definitely don't show up after a search of a statewide narcotic database.

These people don't have to worry about not receiving appropriate treatment for pain. It's the ones that go to the ED multiple times per week instead of following up with a PCP who knows their problem. Also, those people with a potential SA problem will often go from ED to ED in search of their drug(s) of choice. In this case the staff of the original hospital will get on the phone with other area hospitals and state that someone complaining of this problem wanting only narcs is on their way to another hospital to give the staff a "heads up" on the problem.

I know that this appears to be a compilation of the last several posts, but I wanted to point out the difference between a possible problem and someone who has true pain. I hope this makes sense to the OP.

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Specializes in ED, Public Health, Travel.

Im pretty sure that your coworkers were violating HIPPA/patient confidentiality by notifying area hospitals about this woman. Usually the patients PCP has a care plan that states the ED is not to give narcotics. In other cases when the patient does not have a PCP, a case worker for the ED works with the patient to make sure they are going to their follow up appointments to the PCP/pain clinic. Sometimes there is an agreement that the patient can only come twice a month for a shot.

It is unfortunate that there are no resources for these people in the ED. If you think about it, the majority of these people do not have insurance and are not paying their bill. Or they have medicare/medicaid and we are paying for their frequent visits. It might be beneficial for all parties involved if the hospital hired someone that specialized in addiction. Not that this person/team would be able to 'cure' the addiction in the ED, at least it would send these patients in the right direction. And maybe they might think twice about using the ED as their Drug Dealer!

Since you are new, you have a fresh view on the matter. Your coworkers have seen the workings of these manipulative drug seekers day in and day out at work, and are sick of it. An Emergency Room is for emergencies only, and it is very frustrating to take time away from patients that really need you to deal with the seeker. However, unfortunately, this is reality... and we should do something about it.

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Specializes in Emergency Medicine.

Seekers are out there. It will not change anything in the way I treat them.

I administer what the doctor orders, reassess and document appropriately.

The medication isn't up to me...

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Specializes in PACU, ER, Level 1Trauma.
Seekers are out there. It will not change anything in the way I treat them.

I administer what the doctor orders, reassess and document appropriately.

The medication isn't up to me...

What do you mean it isn't up to you? We are not mindless robots here simply to "follow doctors orders". As nurses, it is our responsibility to work as a team member with our docs and to communicate with them. I spend much longer with the patients and observe their actions, facial expressions, etc.. The doctors I work with(NOT for) count on us as experienced, knowledgeable nurses to communicate with them in order to provide the best, most appropriate care for our patients.

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chronic use of opioids only makes pain worse not better. Log In Problems

WHAT???? I can't read the article you are referencing, but I want to because that sure doesn't sound right to me. There are people who need opiates for pain control, especially for the control of cancer pain.

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Specializes in Medsurg/ICU, Mental Health, Home Health.
WHAT???? I can't read the article you are referencing, but I want to because that sure doesn't sound right to me. There are people who need opiates for pain control, especially for the control of cancer pain.

Exactly.

Opiods are great!

However, they need to be respected for the powerful agents they are.

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