CodeteamB

Not that uncommon where I work, I'd say at least half of our "cyclical vomiting syndrome" patients end up with this diagnosis from the ER docs. It does have some easily identifiable characteristics (eg resolves with bath/shower, and of course history of chronic pot use). Marijuana is not legal here, but it is decriminalized, and unless you are growing on a large scale the police aren't going to bother with you. People are pretty much open about their 3 J/day habits and have been as long as I have been working, so maybe that (as Emergent suggests) is a reason for it being identified often here.

The other day I was starting an IV in a rather large vein. I'm a one-shot single motion kind of gal so I stuck the patient, saw flash advanced and occluded, only to realize the patient was bleeding from the site and there was no catheter to be seen. My heart leapt into my mouth and I panicked... I couldn't really process what I was seeing. The only thing I could think was that the entire catheter was inside the very large vein I had just attempted to cannulate. Then I realized that was ridiculous, bandaged the patient and found my malfunctioning catheter lying on the other side of the patient. It had become disconnected and flown off the end of the needle as I swung up prior to my jab. My cavalier style bit me in the butt, but it makes for a good story.

OP, you really did need to give those meds when he asked for them, or you needed to call the doc and get the order changed if you felt that the patient's behaviour was unsafe (although I would be trying to lose the Demerol, not the lortab. That being said, here's a policy for you. We have a very strict no smoking policy. Patients are offered multiple forms of nicotine replacement, but the policy is firm that no smoking can occur on hospital grounds, which are extensive, it's a long walk to get to an acceptable area. I am lucky enough to work in the ER, meaning I have my docs Johnny-on the spot 24/7, so this must be tougher on floor nurses. If I am giving a patient a narcotic analgesic and they have been going out to smoke I warn them that this means they will no longer be able to go out as I need to monitor them. If they then turn around and say they are going out, I tell them no, they must wait x amount of time (our post narc monitoring period). Most will wait, if they walk out I let them go, chart my conversation and talk to the doc. When they return they will find (depending on level of illness): A) they are discharged B) their analgesic options are Tylenol and Ibuprofen C) they get to choose between AMA papers or following the plan of care Going off unit with their IV intact, post medication is a liability issue and should be taken seriously, but you need to cover your butt with orders and policy.