Patients Cheeking medications

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Specializes in Emergency Medicine.

Question: If there is a PO order for pill medications (especially narcotics), are we able to dilute them in water for administration if you suspect a patient of cheeking them? Or should we consult with the ordering physicians prior to dilution?

Being a newbie ER nurse, in the few couple of months I've been in the ER, it's been one hell of a ride considering the patient population. And I know I am not the first and I won't be the last nurse to experience someone cheeking? But in all purposes of protecting my license and not enabling the sale of controlled substances, ie. dilaudid, on the streets, are we as nurses able to do just that? Dilute the pills for administration?

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I don't know about the PO meds, unless they're SR or XR, that's a huge no-no. I always check my pts mouth after they swallow. On the MS floor I clinical on, I have both folks w/ possible pocketing behaviors and those who like to bundle their narcs into one big fun ride by holding their prns for one or two doses and then taking everything. So, I just politely but firmly say I need to take a peek in their mouth and check the buccal folds and palate. Seems to work so far...

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Specializes in Leadership, Psych, HomeCare, Amb. Care.

No. Diluting may cause uneven absorption.Just watch to ensure they are are actually taking their meds...do mouth checks as necessary

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Specializes in Critical Care, ED, Cath lab, CTPAC,Trauma.

no....just a normal patient in the ED no. Make them open thie mouth and show you if you think that is what they are doing...tell your MD

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Specializes in Emergency Medicine.

in some instances, these MDs have known these patients for years! We're talking over 1,500 visit counts.

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Specializes in Emergency Medicine.

Some of these patients are so frequent, they have visit counts over 1,500. And mind you these patients are not over 35.

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Some of these patients are so frequent they have visit counts over 1,500. And mind you these patients are not over 35.[/quote']

OK, and? As far as I have seen, it isn't the nurse's place to decide to change med administration methods. Bring your concern to the Dr, and you've done your job. As someone said above (sorry, I'm on the phone and can't look up their name) crushing the meds may alter the absorption.

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Specializes in ICU.

There could be reasons why they have visits that high. I know in my area walk in clinics don't take medicaid. So any time a person gets ill, they have to go to the ER. For any little reason. Lots of docs in this area won't take medicaid or are not accepting new patients so they have to go to the ER. I don't think that you judging them and deciding for them what their pain levels are and how they should take their meds is right. There are plenty of people who are addicted to pain meds. But that is not your job to judge and try and take matters into your hands. That is the doctors issue.

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in some instances, these MDs have known these patients for years! We're talking over 1,500 visit counts.

What have the physicians said when you brought this to their attention?

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The physician can order it in liquid form prn. The patient can try to pocket it to spit it into a cup to save for later, but you foil that by having him drink some water to wash it down, "... so it will be absorbed properly."

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Specializes in ER, Addictions, Geriatrics.
There could be reasons why they have visits that high. I know in my area walk in clinics don't take medicaid. So any time a person gets ill they have to go to the ER. For any little reason. Lots of docs in this area won't take medicaid or are not accepting new patients so they have to go to the ER. I don't think that you judging them and deciding for them what their pain levels are and how they should take their meds is right. There are plenty of people who are addicted to pain meds. But that is not your job to judge and try and take matters into your hands. That is the doctors issue.[/quote']

I agree with parts of your post however, maybe once you are finished school and actually practising as a real nurse you'll think differently. No it is not for us to judge, but it is for us to determine if a patient is taking the medications we are handing them properly or not.

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The physician can order it in liquid form prn. The patient can try to pocket it to spit it into a cup to save for later, but you foil that by having him drink some water to wash it down, "... so it will be absorbed properly."

Yep, I work in peds. It is a rare treat to give a patient an actual pill that they can swallow. Usually I'm drawing up syringes of the liquid form of the med according to weight.

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