Patients hiding narcotics

[theAMAZINGkilo]

Recently i caught a patient dumping his meds into his lap then pretending to swallow his meds by putting the empty med cup to his mouth. I found his narcotics, he took them, i reported this to his physician, my charge nurse, and charted the event. Since then every time i have administered medication with him ive physically dumped the meds in his mouth asked him to open his mouth afterwards. He complained about all of this to my supervisor. Do i have a right to ask him to open his mouth when i caught him attempting to hide his narcotics?

[AussieRN12]

I would and have done the same thing as you, it sounds like he might have an addiction and could be storing/ hoarding narcotics to get high. In australia (where i live and nurse) the prison nurses do always ask the patient to open thier mouth

[JKL33]

How is your supervisor proposing you handle it?

It is in your facility's interest to have a plan/policy for handling such a scenario. If current medication administration policy doesn't mention this particular situation, it should at least be addressed with the patient by the care team and should be a care plan item that is part of his chart.

They do need to give you some reasonable answers on this; it is a patient safety situation first and foremost, but secondarily as the nurse administering those meds you have a professional/legal interest in knowing they were administered as intended. They shouldn't just shrug their shoulders about a patient who is trying to deceive staff with controlled substances. If he doesn't swallow them, that's no better than if you had just left them on the bedside table and walked away - the meds are "out there somewhere," and clearly we would never do that (nor get away with doing that).

[NurseSpeedy, ADN, LPN, RN]

I've had a physician write an order to crush the controlled med (assuming it can be crushed) when patients have done this. We have a large population of iv drug abuse patients so it's not infrequent where I work.

I always wait until a patient takes their meds before leaving the room (as we should). I have only had one patient get openly bent out of shape when I told him that he needed to take the medication before I left his room. He accused me of treating him like a drug addict and said he wouldn't take any more medication from me. Yeah, that lasted until his next dose was due...this time with a physician's order to grind it to a powder and mix it in applesauce.

[Penelope_Pitstop, BSN, RN]

We had a dude slicker than this. Our hospital gowns had pockets in them for the telepak. This guy would slip his pills into the pocket vs. dumping them on his lap. He hoarded them for days then informed us he was going to kill himself by taking them all. He had a sitter for the remainder of his stay and, yes, we checked his mouth after every med pass. Another patient was caught attempting to inject her crushed Percocet into her PICC. She, too, bought herself a sitter.

Honestly, in this case, a sitter may be overkill but I'm sure the doc would write for an order to do mouth checks for this patient. Not that you necessarily need it, but it least it would exist.

[LadysSolo]

I would do the same thing. Patients can "pocket" their pills in their mouths, and especially with the elderly and anyone with swallowing difficulties you should check to be sure everything is swallowed, so I don't think you should need an order. That is just good judgment!

[Munch]

I've seen docs order the meds to be crushed(unless of course its a long acting narc like ms contin) and mouth checks done after a patient has tried to store their meds. Some may be storing them to get high, I have seen many try to save oral dilaudid and morphine to crush and inject into their lines to get a rush and a couple of times like Penelopes patient, I've seen patients store them to try to overdose on.

I know that getting a straight answer may not be possible if the patient is doing it for truly deceptive reasons but Ive had patients cheek their meds simply because they didn't want to take them at that time. It doesn't hurt to ask the patient if they arent in that much pain then you can get the order changed to PRN status or simply before the med is due ask them if they want it. Patients might be afraid to say they don't want it at that time because they are afraid if they don't take it, its going to be perceived they don't need the order at all(happened to a co-workers patient). Like I said though having a conversation with these patients might be moot because they won't be truthful regardless because they are holding on to the meds for secondary gain.

And my best friend is a nurse at the county jail and any patient(inmate) that has an order for any scheduled drug gets crushed and the inmate must roll up their sleeves if they are long(detox protocols call for valium and suboxone depending on what they are coming off of) because not only can they hoard them to catch a buzz off of, those meds are big currency in a jail/prison setting. Actually my friend said they just started crushing meds like neurontin, remeron, trazodone, seroquel..basically anything that makes you sleepy because inmates were cheeking them and trading them for stuff. And if an inmate is caught trying to do something deceptive with their meds(despite the med being crushed they do try..inmates apparently can be very determined, creative individuals) the order for the medication is discontinued. My friend told me so many stories especially with the suboxone which dissolves anyway. One inmate that was getting suboxone was being shaken down by another threatening their family if they didn't bring it back for them...sad all around if getting through the day revolves around taking second-hand meds that have already been through someone's mouth.