Wait for D/C after narcs/benzos?

Jennifer, RN · Mar 10, 2007

We do not give narcs or sedative drugs to anyone that is driving, period. If a person receives narcs, their ride must come to the room to pick them up. No specific waiting period, but they must be alert and coherent and able to walk on their own.

Jennifer, RN · Mar 10, 2007

This is not a "written" rule, but it's a pretty well known guideline. All newbies are taught during orientation to never give narcs to someone who is driving.

caliotter3 · Mar 10, 2007

I took a cab from the hosp after discharge following same day surgery (even though my MD extended my stay for overnight d/t "pain mgmt"). In reality, d/t weakness r/t blood loss, etc., I should not have been discharged. It was all I could do to get into and out of the cab without passing out. Shortly thereafter, I had another same day procedure and was specifically not allowed to use a cab. The "volunteer" elderly gentleman who gave me a ride home scared the hell out of me. I probably could have driven myself and been just as scared.

Miss Mab · Mar 10, 2007

Thanks for replying so quickly! Keep 'em coming....

Also, although I'd like to know all from my first question for general info, I'm really more focused on if they are specifically NOT driving--or at least "say" they're not and bus token/taxi voucher given.

Thanks

caliotter3 · Mar 10, 2007

In ref to your last post, I was forced to use the volunteer gentleman when I checked in for the procedure. Even though I stated I had gotten there by cab, and planned on leaving by cab, the staff told me that was not an option. They did not say why.

lorita · Mar 10, 2007

We don't give narcs or benzos unless they have a ride and the person must be present when we give it because we have had them call for their ride and noone shows. We had a woman really pitch a fit on this one she wanted to be admitted for her migraine because we would only give her a script she could take at home. :uhoh3:

neneRN, BSN, RN · Mar 10, 2007

We can't D/C without a ride unless they stay in the ED 4 hours post administration of any med affecting CNS. For those that have a ride, we have to document that driver is at bedside and what their name/relationship is-also have to document that pt has been educated re med side effect. (This is all preprinted on our nursing flow sheet as check off boxes and a blank for the name of the driver)

TazziRN, RN · Mar 10, 2007

Wait 15 minutes after any injected med, narc or not. Pts do not get narcs via any route unless I see the whites of the driver's eyes. Been burned too many times with "My ride is in the waiting room/car/dining room/lobby waiting for me."

sissiesmama, ASN, RN · Mar 10, 2007

Miss Mab -- good question, because where my husband who is also an RN and I work usually follow the rules, have a ride, ect until those VIP, or PIA's come in and think that the rules don't apply to them. Of course it would be somebody's tail in the ringer if they had a wreck or something, God forbid. I always try not to end up in that sitation, and involve someone higher up the food chain to handle the situation.

But the VIP/PIAs aside, we always have some that say "oh, yeah my ride ill be out front of the ER doors, but they want me to wait out there." And I have been the mean nurse and told them, "Well, I need a little air, so i'll wheel you out,,,'.

Another facility I have worked in does the taxi voucher, and the ER staff calls the cab company. I have caught patients wandering the ER hall getting closer and closer to the doors, and of course to where they parked their car, trying to make a quick exit.

If the pt is getting a script for narcotics, they see the rx when I see the whites of the driver's eyes. Sounds too cynical, doesn't it? You just get irriitated seeing it over and over, esp. when other nurses look the other way.

Anne

Altra, BSN, RN · Mar 10, 2007

The reasons that you all have given for waiting for discharge after med administration, or waiting until the pt.'s ride arrives, are valid.

My experience in the ER where I work is totally different.

I'm just asking - how do you know how someone arrives or leaves? Can you see the parking area from triage or the waiting room? Do you not really not give narcs/benzos to anyone who has driven themselves and intends to drive themselves home? Wow.

Other than pts. who arrive via EMS, I don't have the slightest idea how many of my pts. arrive. My ER is smack in the middle of the city. They may have driven, they may have been dropped off, they may have walked, taken the bus, gotten a jitney or cab ride ...

No one would discharge a pt. who was unsteady, lethargic, etc. ... but as long as they're steady on their feet, alert, and not nauseated ... out the door they go. I'm not saying that's the best practice, but I am saying that in this particular setting I don't see how it could be any other way. The ER is the primary or only health care for probably 1/3 of our patients. To not treat complaints because a patient arrived alone ... it just wouldn't fly.

Also, a majority of our patients are not, lets say, *opiate naive*.

On the other hand, it's not unheard of for a pt. whose address is within several blocks of the hospital to come in w/a vague, bogus complaint and then make a big deal of demanding a bus ticket ... they have places to go, doncha know. And they need a sandwich too ... but I digress. :nono:

Miss Mab · Mar 11, 2007

Thanks all, for the responses.

Apparently, MLOS and I work in the same place!

Sometimes feel stuck between a rock and a hard place. If I don't medicate--ooohh, what a mean ER nurse I am----if you do, short of physically barring them from leaving (assault, anyone)---it feels like a no win.

Okay, continued CYA charting it is! :)

Thanks again...