I work in a SNF where we recently admitted someone S/P ORIF of the femur for a short term rehab stay. This patient is in their mid 40s and among their very lengthy list of diagnoses there is a history of drug abuse. It's actually listed multiple times t/o their dx list "history of drug abuse. Has been clean for many years", "history of opiate abuse with misuse, overdose, and diversion", and "history of narcotic drug dependency with misuse, overdose, and diversion". They were admitted with orders for MsContin, Oxycodone PRN, and Xanax. Upon admission this patient was rating their pain a "12" on a scale from 1-10! They did not display any nonverbal sx of such pain... Within a few hours of their admission they were adamant that they were supposed to have orders for Lortab PRN along with the other narcotics. Since admission this patient has displayed drug seeking behaviors, demands the max amount of PRN Lortab every 6 hours to the minute (order is for 1-2 q6hr PRN), has attempted to manipulate the nurses into administering it earlier "that other nurse said I could have it every 4-6 hours...), has demanded that a MD is contacted to change the order to q4hr, wants the PRNs scheduled so they can self administer them (which we'd never allow), and yells at the nurses for not bringing their scheduled MsContin in within 10 min of the scheduled time (they got noon dose at 1150 and was upset that they didn't get it sooner)...
Am I wrong for questioning why an MD would order MsContin, Oxycodone, Lortab, and Xanax for a patient with a history of drug abuse/dependency?! Is it appropriate to have it listed on their Dx list that they've "been clean for many years"?
