Accused of not giving dilaudid

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turtlesRcool

718 Posts

She refused the order 1.5 mg dose originally and only took 1 mg then changed her mind before I left the room I gave her the additional .5 mg as ordered. So no new order needed to be gotten.

This makes sense. I frequently have different doses of the same medication ordered for different levels on the pain scale. If I'm not sure what the patient wants (such as when my PCT calls me and says a patient is asking for pain medication), I will sometimes pull the larger dose, and then either return or waste (depending) any remaining amount.

There are some people who request a smaller dose for a variety of reasons. Some patients are worried about addiction and don't want to take any opioids if they can help it. Others don't like the fuzzy-headed feeling or lethargy that can come with those medications. Opioid-naive patients may only need a smaller dose to achieve effective pain relief.

OP, one thing I do when I'm administering any medication is to tell the patient exactly what I'm doing as I'm doing it. So, for an IVP medication, I'll start by saying, "I'm going to start with some saline to make sure your IV is working properly. This isn't a medication, just some IV solution. Then I will give you the medication with this syringe, and follow it with another flush of saline." Then as I switch syringes, I state what I'm hooking up as I do it.

Of course, if you have a patient who is a liar, you'll want to bring a witness, as that's a whole different matter. But for ordinary patient interactions, I find it helpful to just be really clear so patients and their families know exactly what I'm giving.

Meriwhen, ASN, BSN, MSN, RN

4 Articles; 7,907 Posts

Specializes in Psych ICU, addictions.

Rule #4 of nursing: if at all possible, never take care of a patient that you've had a pre-existing relationship with. This includes family members, friends, coworkers, romantic interests, etc. There's too much potential for drama...it's not unheard of these patients expecting "special" treatment from you because they know you from the outside. It's also a conflict of interest on your part.

Explain to your charge/NM that you have a conflict of interest related to an existing relationship with this patient and request another patient assignment. It may not happen that same shift, but they'll address it. They're aware that it could be a potential problem and they don't want to deal with that problem any more than you do.

More than once, I've asked to be assigned to a different unit because I knew a patient or patient's family member. My request has never been turned down.

psu_213, BSN, RN

3,878 Posts

Specializes in Emergency, Telemetry, Transplant.
She refused the order 1.5 mg dose originally and only took 1 mg then changed her mind before I left the room I gave her the additional .5 mg as ordered. So no new order needed to be gotten.

I realize that you ended up giving 1.5 mg. But, question for the group--if the order is for 1.5 mg PRN, can you just give 1 mg because the pt requests it? Just curious.

Specializes in Med-Surg, Geriatrics, Wound Care.
I realize that you ended up giving 1.5 mg. But, question for the group--if the order is for 1.5 mg PRN, can you just give 1 mg because the pt requests it? Just curious.

I've always tended to view it as "the patient has the right to refuse". So, if the patient refuses a portion of a medication, and it does not harm them, then I am fine with refusing part of a dose. Even if it is something the Pt needs, giving them part instead of the whole can at least get them something which is more than others. So, document refusal, inform physician if needed. But, the patient has a right to refuse.

psu_213, BSN, RN

3,878 Posts

Specializes in Emergency, Telemetry, Transplant.
Rule #4 of nursing: if at all possible, never take care of a patient that you've had a pre-existing relationship with.

Exactly. This was my first thought when I read "This patient was a friend of mine...." That was before I even read the rest of the situation. It does not matter if they are a chronically complaining PITA or if they are sweet as pie. Go to the charge nurse, tell him/her that you know the person, and you are not able to be her caregiver.

When you are nurse, people are going to file ridiculous complaints against you--it is just a sad truth about being a nurse. However, IMHO, the real issue is in having a (former) friend as a patient. Unfortunately, you were set up for something not-so-good to happen.

JKL33

6,777 Posts

I've always tended to view it as "the patient has the right to refuse". So, if the patient refuses a portion of a medication, and it does not harm them, then I am fine with refusing part of a dose. Even if it is something the Pt needs, giving them part instead of the whole can at least get them something which is more than others. So, document refusal, inform physician if needed. But, the patient has a right to refuse.

Ditto - the patient refusal being the key part. "1 mg given d/t pt declining remainder of dose." I have begun documenting all CS wastes in the medical record as well as the dispensing machine's waste process, as suggested on AN by pharmacy person several months ago. I would also get a different order as appropriate if the pt. decided sometime later that they wanted the remainder/didn't receive adequate relief, since the original order didn't say, "give pt-specified doses according to pt. request up to 1.5 mg total in [time frame]."

HomeBound

256 Posts

Specializes in ED, ICU, Prehospital.
Like others have said, forget about it. This certainly won't be the last patient like this if you stay in the field.

I distinctly remember one patient a few years back that did this sort of thing, and would say things like, "I know how you nurses are" and what not so it got to the point that we would take the unopened vial into the room and draw it up and talk him through the process. It was annoying, but life went on.

There's a good chance too that if you diluted the med maybe one of your coworkers had not, so she didn't feel the rush of the pure drug going in and so thought she didn't get any.

Just make sure you're documenting everything, including her accusations. Then forget about it.

I only have ED experience with this behavior--not floor, so it's kinda different. But yes, this woman seems to have a baseline for how she "feels" when she receives narcotics--and you did this a different way.

Documenting the living hell out of this type of thing is essential. I never say the words "seeker"--but I sure as **** make my implications point to nothing other than....this patient wants to be high. "slow push as per policy", "diluted as per policy".

There is a post here somewhere that someone made a brilliant leap--and I wish now I had a few ED shifts on which to practice it---

She said, that if the patient continually asks for narcotics, because after 2-3 full doses they still have "10/10 pain", she then converts to---we need to try something non narcotic because OBVIOUSLY narcotics are not easing your pain. THAT gets their attention---and you document accordingly...that you feel that the patient is not being helped by this medication and that escalation is futile because of it.

As others have said. Don't treat friends, colleagues, neighbors, relatives, or even loose associations. I made the mistake of visiting my own ED for cp. The poor RN who had to put in the IV/draw blood was actually shaking. She was so nervous she would miss and what would I think/do? I won't do it again. Open season for the mentally unstable or the perpetual litigator to catch you off guard.

As for administering dilaudid--it came in 2mg vials most places I worked. I could give as much or as little as the patient "wanted"---but again....DOCUMENTATION of said refusal as well as witness on waste...every single time.

EPIC also has a very handy dandy little whistle, that I am not sure every place has installed---but you can waste at bedside...and document it in Pyxis via EPIC. You don't have to be in the med room to do it anymore. Check to see if your employer has it, if they have EPIC. It was a life saver at one of my ED jobs---because I would bring the meds to the bedside, draw everything up in front of said problem patient (usually a seeker), and then waste right there if the patient was trying to be cute and refusing parts of it.

Oh. I also am a beyotch where I don't just dilute in a 10mL flush. If I suspect the pt is a seeker or a problem? I'll put it in a 50mL bag if they are on fluids (which they usually were in the ED. again, different for the floor). Didn't put it on a pump (which was tempting), but I sure as hell am not participating in this "buzz seeking".

I also don't ever, EVER inject narcotics at the angiocath site if they are on fluids. I go all the way up to the first port of the fluid bag and inject over the full 2 minutes. Want to see an RN get fired from a pt's care within 10 min of meeting? Do this. Seekers know.

As long as you documented every single thing you did that would possibly get you or your hospital into trouble? She can report anything she likes. If you are one of those RNs that is always getting these complaints, I would worry, but I am assuming you are not.

A friend quit nursing after 30 years because of litigious patients and their families. Some told her to her face that they were watching everything she did so that they could find something to sue the hospital over.

Do your job. Document everything. If you feel uneasy, ask a Charge to come and witness any procedures/med admin that you may feel could end up in contention. When admin has to be pulled in time and again, particularly if you do things like I did---walk into the MD box and bring them into the situation. These types of litigious patients can't control many of us at the same time--if a witness and/or MD are in the room, there is no opportunity for bending the truth.

jena5111, ASN, RN

1 Article; 186 Posts

Specializes in Tele, Interventional Pain Management, OR.

When/where I worked on the floor, Dilaudid came in 2 mg/mL syringe. So wasting was pretty much ALWAYS required (sigh). And wasting required a witness, whose credentials were typed into the Pyxis along with my own.

OP, did anyone SEE you waste that last bit of Dilaudid? I'm not suggesting you didn't but this whole thing may be a crazy uphill battle without a witness.

And...you've learned a lesson here about caring for folks that you know. Don't! You never know what strange dynamics will emerge in that situation.

Good luck, OP!

Career Columnist / Author

Nurse Beth, MSN

146 Articles; 3,468 Posts

Specializes in Tele, ICU, Staff Development.
I realize that you ended up giving 1.5 mg. But, question for the group--if the order is for 1.5 mg PRN, can you just give 1 mg because the pt requests it? Just curious.

If the order is for 1.5 mg the nurse cannot change the dose anymore than if 20 mg of Lasix was ordered and the nurse only gave 10 mg.

ORoxyO

267 Posts

People make stuff up. It's irritating.

Once had a patient freak out in the middle of the night claiming that I ate her sandwich. She made the charge nurse call my manager at home to report me because she SAW me eat it. I left at 11pm so I wasn't there for the show, but did get a lovely wakeup call asking if I had seen this damn sandwich. Management apologized up and down to the patient and ordered out for a sandwich because our kitchen was closed. Irritated the s*** out of me. Of course I didn't touch a patient's nasty sandwich. She didn't even have one. My manager never doubted me but gave in for patient satisfaction.

My point is this: people will always lie and complain to get free stuff or special accommodations. It's obnoxious but isn't going to end any time soon. Do your job well and document fully and your overall performance will speak for itself.

kataraang, BSN

129 Posts

Specializes in critical care ICU.

I had a patient file a formal complaint and threatened legal action because I didn't flush before and after a med (total lie), that I gave his med late (he refused it at the scheduled time), and that I acted "annoyed" at him.

It bothered me for a few days. And I was concerned he might try to escalate it...but so far he is discharged and I haven't heard anything. He complained about every nurse that took care of him. It was a blow to my pride but now I don't care. Next case!

I understand OP's anxiety though. Some patients can get under your skin try as hard as you might to not let them.

Take care of yourself and just do your best with every patient you encounter!

luv2

161 Posts

This a teachable moment. Do not let this person break you and what your goals are in life.

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