The drug-seeker file in ER

Mobeeb, RN · Feb 3, 2008

In our ED of Level 1 Trauma Center, we encounter many folks wanting pain meds. As a matter of fact, Tennessee was listed as the #1 state for drug abuse in 2007. I know, kinda hard to believe that southeners would switch from Jack Daniels to oxycontin, percocets, etc. Anyway, our docs have access to a state sponsored website which lists all controlled substance prescriptions with date filled, quantity given and prescriber. Therefore, folks can't lie and say they haven't had any narcotics or Soma or other local favorites.

Diary/Dairy, RN · Feb 3, 2008

It's a great idea.......

mom2michael, MSN, RN, NP · Feb 3, 2008

At my old job......we once had a book....they took it away because it violated the patient's right to fair treatment and they felt that our ER docs would consult the book rather than the patient.

This of course occured after a lawsuit where a person's name was *in the book* for repeated drug seeking behaviors and the patient eventually died from a missed Dx.

NurseCherlove · Feb 4, 2008

WOW! COOL! And I don't even work in the ER. Now if we can just stop these folks from getting admitted - well, that'd just be the icing!

Sorry, I still have to say it's a great idea, despite the sad story above. After all, I don't care how many times a person cries wolf, those docs still have a responsibility to assess these patients as thoroughly as any other patient.

HOWEVER, I also think that there should be some kind of abridged version of each admission added to these patients' files (including such things like how often they received their DOC - was it every 4 right on the hour, etc.?). Sorry, let me stop.

LilgirlRN, ADN, RN · Feb 4, 2008

We stopped doing that years ago. We had "the seeker book", we got sued because of the seeker book

Simplepleasures · Feb 4, 2008

About 5 years ago, I ended up in the ER, I was in intractable pain . I was given multiple doses of various narcotics and valium per IV, none of which helped. I had a trapped nerve in my lumbar spine and my leg was in a constant spasm from hip to toe. The ER staff could not believe that all the meds they gave me did not relieve my pain. I was not taking anything stronger for sciatic pain than ibuprofen before this event.

They actually dragged me by the arms to try to get me to sit up and walk! My leg was so numb I couldn't bare weight, yet the awful spasm did not release. I begged for a different muscle relaxer other than valium, which did NOTHING. The ER resident kept putting his foot on my gurney and shaking it, I found out later this is something they do when one is suspected of drug seeking, why, I have no idea.

The spasm finally released after about 5 hours of this torture, I was made to feel like a druggie off the street. I later file a complained with the hospital and was told that the ER resident would be disciplined.

It is imperative as health care providers that we do not jump to conclusions when patients come in complaining of severe pain.

bollweevil · Feb 4, 2008

About 5 years ago, I ended up in the ER, I was in intractable pain . I was given multiple doses of various narcotics and valium per IV, none of which helped. I had a trapped nerve in my lumbar spine and my leg was in a constant spasm from hip to toe. The ER staff could not believe that all the meds they gave me did not relieve my pain. I was not taking anything stronger for sciatic pain than ibuprofen before this event.
They actually dragged me by the arms to try to get me to sit up and walk! My leg was so numb I couldn't bare weight, yet the awful spasm did not release. I begged for a different muscle relaxer other than valium, which did NOTHING. The ER resident kept putting his foot on my gurney and shaking it, I found out later this is something they do when one is suspected of drug seeking, why, I have no idea.
The spasm finally released after about 5 hours of this torture, I was made to feel like a druggie off the street. I later file a complained with the hospital and was told that the ER resident would be disciplined.
It is imperative as health care providers that we do not jump to conclusions when patients come in complaining of severe pain.

Having suffered with this ailment myself recently, although not to the degree you describe, I am sooo sorry you had to endure this.

And I know how you must have felt about the lack of compassion and comprehension by those caring for you.

I think the book is a horrible idea, as it allows staff and doctors to label a patient without a full exam, without an open mind. Remember the old adage of innocent until proven guilty. Also, walk a mile in my shoes.

Batman24 · Feb 5, 2008

The best thing since sliced bread. New York state started keeping close eye on patients who bum miltiple practitioners for narcotics. Our doctors and PAs began to get written notifications to their home regarding individuals who seek drugs. The letters list their names, who they've seen and what scripts were filled.
One of our doctors created an alphabetized binder with patient's names and records. Now we actually have real evidence on grounds of which we can refuse prescriptions, not just "the hunch".
Nat

Do you have a link to a website that has the info?! I looked and can't find a thing on the Internet. This would be good for a report I have to do.

I find it a horrible idea. I'm not surprised to read about the lawsuits, disciplinary action, and terrible care that arose of a result of it in hospitals. Lists of patient's names, who they've seen, and what drugs they've taken sent to doctor's homes absolutely astounds me. I'm shocked that it would be legal and not violate HIPAA standards.

If you can direct me to anything written I would greatly appreciate it. Please know I don't doubt what you are saying to be true or factual. I just needed something written to back it up included in my report. TY.

Larry77, RN · Feb 5, 2008

We have electronic charting and if a patient displays obvious drug seeking behavior there is a "flag" to read the transcription explaining the event. This does not "label" them a "drug seeker" but is information for the current provider from previous experiences with the patient.

We also have filed "careplans" for patients who have a contract that they sign or at least receive a copy of--basically is a plan for the care that we will provide for the existing condition (ie. Reglan and Benadryl for a migraine...NOT Demeral). The patients who have these are aware of them and don't expect or usually even ask for any other tx.

Also if the patient has a PCP that prescribes a long-term narcotic for a chronic condition they are flagged with a "pain contract" on their chart and we are not allowed to give more narcotics for a previously existing condition but of course do if they say break an arm. If a patient is having continued pain and is a "pain contract" patient they have to go to their PCP for a change in medication not us.

In the above scenario about the muscle spasm our system would not have harmed her or prevented us from treating her condition accordingly. I don't understand why they would treat her like that unless there is more to the story that we are not hearing.

Simplepleasures · Feb 5, 2008

We have electronic charting and if a patient displays obvious drug seeking behavior there is a "flag" to read the transcription explaining the event. This does not "label" them a "drug seeker" but is information for the current provider from previous experiences with the patient.
We also have filed "careplans" for patients who have a contract that they sign or at least receive a copy of--basically is a plan for the care that we will provide for the existing condition (ie. Reglan and Benadryl for a migraine...NOT Demeral). The patients who have these are aware of them and don't expect or usually even ask for any other tx.
Also if the patient has a PCP that prescribes a long-term narcotic for a chronic condition they are flagged with a "pain contract" on their chart and we are not allowed to give more narcotics for a previously existing condition but of course do if they say break an arm. If a patient is having continued pain and is a "pain contract" patient they have to go to their PCP for a change in medication not us.
In the above scenario about the muscle spasm our system would not have harmed her or prevented us from treating her condition accordingly. I don't understand why they would treat her like that unless there is more to the story that we are not hearing.

You may not be able to say why I was treated like a drug seeker in the ER, neither can I , I assure you. I am a 56 year old grandmother who has been a nurse for 30 years. Why is it so difficult for you to believe my story, because it shines a shameful light on ER staff? Cruel behavior is hard to understand, especially if one is the victim of such behavior.

Larry77, RN · Feb 5, 2008

I'm sorry if I sounded insincere what I meant is there is two sides to every story and I just don't understand why they would treat you the way you say they did--I know me or my co-workers would never treat a normal person badly. It would be different if you were always there and you were allergic to all px meds except Dilaudid or Demeral.