In our department, we have a very wealthy patient who is a frequent flier. He comes in every two weeks for either an EGD or a Flex Sig. But he wants and demands IM Demerol in prep and then again in recovery. He absolutely denies pain and he just tells the nurses, "They just give me the drugs". The two doctors involved in his care are aware that he does not have any pain issues, but they automatically write for the drug every time he shows up.
The problem (besides all of it) is that he is a major donor to the hospital and if anyone refuses the drug to him, the thought is that he will just call administration. He is receiving these procedures under anesthesia and is also non-compliant with the admonition not to drive after the procedure. He drives himself home immediately after getting Demerol IM in pre and post and anesthesia on top of it.
Talking to leadership has not helped. Many of the nurses are understandably uncomfortable with the idea of administering this medication to a patient who does not endorse any pain and clearly just wants the drug because he wants it. The issues are what if this person drives in their car under the influence of anesthesia and Demerol and gets into an accident, either harming himself or another innocent person? And what kind of influence would a wealthy donor have over a nurse's job (if any)? Would a hospital back the nurse against a wealthy donor or would the nurse's job be in jeopardy?
The nurses want this brought to the ethics committee, which will be done. But in the meantime, does anyone have any thoughts about this or maybe even prior experience with a situation like this?
If someone is impaired when they leave our ER we call the police. We don't give medical details, just describe the behavior as they were walking out that made us think they were not safe to drive.
Specializes in Former NP now Internal medicine PGY-3.
I would not RX anything nor allow a patient to leave after having any type of narcotic and then drive home. If the hospital gave any push back I would quit and report them to the state, and as above call the cops if he leaves impaired. Not sure if nursing has that much ability to fly the coup though without repercussion. I am not sure where to go from a nursing standpoint but technically the docs could be reported to the state board of medicine for caving to that garbage.... esp if he crashes his car afterward.
Not even sure how they get away with Q2 week flex sig and endoscopy, unless he's paying cash.
Id quit that place sounds just like the tip of a turd iceburg
I'd be iffy about continuing to work in a place like that as well... You can do everything right, however that doesn't mean that others will change their practice. Unfortunately, sometimes it's only until something bad happens that people will change.
Don't be their scapegoat. Maybe refuse the assignment. Swing it in a way that makes it sound like you and this patient don't get along and that you don't want to create an uncomfortable situation for the patient (just focus on the patient satisfaction stuff). And if push comes to shove, absolutely protect yourself, and say you're uncomfortable administering the medication. Be sure to check your policies on this: if there's a situation where a nurse is uncomfortable or feels like this is a patient safety issue then there should be something in a policy somewhere that allows for the nurse to speak up. Worst case scenario is a write up. Yes, termination may also be possible... Better that to happen than an actual patient safety issue arise from this PLUS you losing your license...
My answer: give the VIP placebos. If he/she asks about it, don't answer. Shrug, disappear.
Wow- you're really recommending someone knowingly administer the wrong medication and falsify charting? You don't think that would set them up for an opioid diversion situation? This is the worst "advice" ever.
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canoehead, BSN, RN
6,909 Posts
If someone is impaired when they leave our ER we call the police. We don't give medical details, just describe the behavior as they were walking out that made us think they were not safe to drive.