RN rights and responsibilities

Nurses Medications

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I have a question regarding a patient who opens her neurontin capsules and snorts/ licks the powder and also chews her dilaudid and Percocets as I'm administering them to her. I've explained several times she is not supposed to and that it can be dangerous but she is manipulative and begins to cry then tries to get me into trouble by saying I'm rude to her and she straight up lies to my charge and nurse manager. The patient has a well documented history of various substance abuse issues, but has had major surgery and clearly needs pain relief. I'm already uncomfortable administering a dump truck full of meds to this 90 pound wonder, but her unwillingness to follow admin outlines scares the hell out of me. I've brought it up with my charge nurse, who told me not to worry about it because "that patient will outlive us all." I also charted a note about it but I'm still faced with her uncooperative stance every shift. She's going to be on my unit for the next 30 days or so, which doesn't make it possible to just hang in there and wait for her discharge. I find her slumped over, slurring her words, and unable to stand, and I document this too.

So... where do I stand if something happens to her? Overdose or a fall... Am I "allowed" to refuse to administer meds if she doesn't just swallow them instead of chasing a high by chewing and snorting them? Do I have the right to refuse to pass meds to her? This is a serious ethical (I don't want to feed an addiction) and safety dilemma in my eyes. Am I being overly cautious or is my charge nurse being flippant? I'm beyond frustrated not knowing how to reconcile the situation.

Thanks for replies in advance.

Specializes in Psych, Addictions, SOL (Student of Life).
I have a question regarding a patient who opens her neurontin capsules and snorts/ licks the powder and also chews her dilaudid and Percocets as I'm administering them to her. I've explained several times she is not supposed to and that it can be dangerous but she is manipulative and begins to cry then tries to get me into trouble by saying I'm rude to her and she straight up lies to my charge and nurse manager. The patient has a well documented history of various substance abuse issues, but has had major surgery and clearly needs pain relief. I'm already uncomfortable administering a dump truck full of meds to this 90 pound wonder, but her unwillingness to follow admin outlines scares the hell out of me. I've brought it up with my charge nurse, who told me not to worry about it because "that patient will outlive us all." I also charted a note about it but I'm still faced with her uncooperative stance every shift. She's going to be on my unit for the next 30 days or so, which doesn't make it possible to just hang in there and wait for her discharge. I find her slumped over, slurring her words, and unable to stand, and I document this too.

So... where do I stand if something happens to her? Overdose or a fall... Am I "allowed" to refuse to administer meds if she doesn't just swallow them instead of chasing a high by chewing and snorting them? Do I have the right to refuse to pass meds to her? This is a serious ethical (I don't want to feed an addiction) and safety dilemma in my eyes. Am I being overly cautious or is my charge nurse being flippant? I'm beyond frustrated not knowing how to reconcile the situation.

Thanks for replies in advance.

Most pain medications have hold parameters. You are well within your rights to withhold a medication if in your nursing judgment it would be unsafe. Just make sure you are thoroughly documenting your reasons for with-holding the medication. As for chewing and snorting her meds all you can do is document your teaching and include a line like "Pt verbalized the risks of this behavior including possible death"

If you voice your concerns to your manager or charge and are told to give the meds anyway - you can respectfully reply- "in my nursing judgement it's unsafe at this time if you would like to give the medication you may do so." Again you must be sure to thoroughly document this kind of exchange.

Hope this helps

Hppy

Thanks for your reply, Happy. It really seems like there should be more we can do than to be glorified enablers, but maybe it's just my way of thinking.

Specializes in OR, Nursing Professional Development.

Has the prescribing provider also been notified? I would think that's a step that needs to be taken as well.

Specializes in Critical Care.

Since there is no significant harm in chewing immediate release dilaudid or Percocet I would give her a quizzical look but there wouldn't be any reason not to give them, I wouldn't however give her extended release if she is intent on chewing them.

Same goes for the Neurontin, the capsule is only to hold the contents, it can be opened and the contents can be given without the capsule without any harm to the patient. "Snorting" the Neurontin is unlikely to result in higher peak levels, since even if more drug enters the bloodstream in a short timeframe it's bioavailability decreases and it's onset is slow to begin with.

Has the prescribing provider also been notified? I would think that's a step that needs to be taken as well.

Agree. If she were my patient the first thing I would do is contact the provider and document having done so.

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