Post accident drug testing

[Sassy5d]

Completely frustrated yesterday at my duty to do a proper post accident drug test and my duty to make my pt comfortable.

It was not from lack of trying, pushed tons of PO fluids/iv. Person could not urinate. Even st cathed and still could not get enough urine for a split sample. I've never ran into this. Even the cath only gave me about 30ml of urine, concentrated.

I documented my efforts but finally said this is ridiculous. The pt had a legit, painful injury and although they were being a trooper, after much time wasted, delaying his needed testing, I gave the ordered narcotic pain medication.

Guess I'm just venting. I sent a single sample and wrote on the paperwork. Observing them, I know how important the sample was, as theirs a good possibility they are struggling with a drug problem and if I had to bet, they would fail. That's not my concern. I tried my best.

Anyone else run into this??

[1fastRN]

It is my understanding that they are further able to analyze drug screens for more specific levels/concentrations of the drug and also narrow it down to what type of drug it is.

So a drug such as dilaudid/fentanyl/morphine would come up differently than more common street drugs. But this is just an assumption; i've never been in this situation.

In my eyes, treating the patient's pain comes first as long as it's justified. And if you charted your efforts than you should be fine. We're not the police and I honestly hate when I run into a situation where a drug user is in legitimate pain and the MD does not want to medicate them. Yeah they might have a problem, but you're not going to treat the guy who has a visible fracture?? Come on doc, we're not going to fix them in a day or create a drug addict from one dose so let's atleast treat the pain!

I've also had situations where critical patients are held up because radiology doesn't want to do their CT because we don't have a urine pregnancy result. Ok, let's let the trauma patient bleed to death internally while we await a urine sample...

[Altra, BSN, RN]

I really can't even wrap my brain around what you seem to be saying here.

A patient who has been injured on the job is ... just a patient with a traumatic injury, which we treat appropriately from a medical standpoint. Medical care, including pain control, does not deviate depending on where the injury occurred. Are you saying that medical care of patients is altered to accommodate the request of private employers?

I have worked in two different Level I trauma centers ... trauma protocols, including rapid CT imaging, do not include waiting for urine hcg results. If the mechanism of injury is such that there is reason to want a scan of chest/abdomen/pelvis ... you scan. There is no benefit nor reduction of risk to the fetus by potentially missing maternal injuries due to delaying standard protocol imaging.

[1fastRN]

I have worked in two different Level I trauma centers ... trauma protocols, including rapid CT imaging, do not include waiting for urine hcg results. If the mechanism of injury is such that there is reason to want a scan of chest/abdomen/pelvis ... you scan. There is no benefit nor reduction of risk to the fetus by potentially missing maternal injuries due to delaying standard protocol imaging.

Same at my facility. But every now and then I'll get some nitwit radiology tech who isn't getting the big picture. It shouldn't have to be explained why a critical imaging study is needed STAT.

[Anna Flaxis, BSN, RN]

In my opinion, your duty to obtain a post accident drug test is secondary to your duty to treat the patient medically. Obtaining a UDS should not delay medical treatment, including treatment of pain.

Remember that the UDS results will be screened by an MRO, who will investigate any positive results. Simply documenting "pt. unable to void at this time, medicated for pain per MD order", and then documenting later on when the urine specimen was collected will assist the MRO in understanding the sequence of events and why the sample lit up for opiates.

Your duty as the nurse is to the patient, not to the patient's employer.

[toomuchbaloney]

Nurses are patient advocates who function within a health care team.

Nurses are not corporate advocates who function within a legal or law enforcement team.

[ParalyticAgent]

In the EDs I've worked, it's been policy to request a urine sample for UDS only after a patient has been medically evaluated and treated. One ED went as far as to say the patient must be discharged, with papers in hand before a sample for UDS could be requested.

Need for a UDS is never a reason to withhold pain medication.