Well most of these addicts that I speak of usually have some sort of chronic problem or something that has probably led to addiction and/or opioid tolerance. I don't work in our ER but I'm sure they have such a "list."
I'm mainly talking about something like this for example.....Take a sickle cell crisis patient that has the crisis resolved after a few days of treatment and is ready for discharge but still continues getting that 2mg of dilaudid q2h. Then, I'll see a fresh post op patient getting something like 2mg of morphine q4h laying in bed crying needing more pain relief, nurse calls the doctor to try to increase pain med with no success.
Another example.......pancreatitis patient with only slightly elevated enzymes, again resovled and almost ready for discharge and still getting the strong stuff like 1-2mg of dilaudid q2h, again while the room mate, brand new post op, is just getting 2 of morphine q4h.
I guess It just depends on the doctor, who knows. At times, it's scenario's like this that get very frustrating, because there are some patients that are in a lot of pain. And, I'd say approx 95%, or more, of my pts that can get oral or IVP pain meds q2-4h, whatever the time frame may be, will ALWAYS want it spot on each and every time, on time, regardless; they say they are in pain and they want the drugs! And most pts want the pain med to be automatically taken to them without asking, happens a lot even after explaining to them the need for further pain assessment prn.