What is the pain med of choice?

Nurses General Nursing

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I have been a nurse for 11 years and in the past year or two I have noticed that we are giving more and more Dilaudid IV for complaints of pain. It doesn't matter what kind of pain, the house doc just orders Dilaudid 1-2 mg IVP Q 2 hr for pain.

Is this happening at your facility? Why the switch from morphine to dialaudid....It is causing a lot of problems for us because the drug seekers are coming out of the woodwork with "abd pain" to get Dilaudid.

We have had to narcan several patients due to over sedation. But if you don't give them Dilaudid they throw a fit. They are now asking for this drug specifically when they come in.

I personally went into nursing to take care of sick people not to be a drug pusher.

So what are thoughts on this? I am afraid that someone is going to get hurt if one of our "druggies" go off the deep end.

In response to the question "why was she admitted with bronchitis and a Headache?"

We have this ER doc that admits everything...He doesn't want to deal with anything himself so he sends it to the floor. She was probably acting out in ER and got shifted to us. Our medsurg is the dumping grounds for everything.

I wish that our house doc would use a tiered approach to pain management....I honestly think that the word is out in the community that you can go to the hospital and get Dilaudid if you complain of abdominal pain.....Mind you we have a small 25 bed facility and one week every other admission was abdominal pain.

Everyone got Dilaudid and 90% of their workups were negative.

The community is small and everyone knows who the drug seekers are but they get admitted and get thier "fix" anyway.

Just the other night a patient got very upset with the night shift nurse because she caught her huffing lighter fluid. The patient was mad because she got caught so she took it out on the nurse.

I am really sick of the druggies that are using our hospital to get their highs.

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I work in small hospital too, we have our frequent flyers. Like the above poster, most of ours are chest pain, they know we can't refuse a chest pain and they are given the "good stuff", at least until they rule out. I know there is always that ONE chance that they are going to have something really serious going on, but it's almost like the little boy that cried wolf, you see these people the week before the checks come out EVERY MONTH. Don't get me wrong, we treat them the same as everybody else, I would never mistreat a pt. on purpose and truth be known, it just isn't worth risking my job and license. The M.D. are the ones that write the orders not me. It's just really frustrating, when you have been a nurse for many years your gut can tell you things that a test never will!!!!

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Sharrie,

Thanks for the web link...

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Specializes in Pediatrics.
I work in small hospital too, we have our frequent flyers. Like the above poster, most of ours are chest pain, they know we can't refuse a chest pain and they are given the "good stuff", at least until they rule out. I know there is always that ONE chance that they are going to have something really serious going on, but it's almost like the little boy that cried wolf, you see these people the week before the checks come out EVERY MONTH. Don't get me wrong, we treat them the same as everybody else, I would never mistreat a pt. on purpose and truth be known, it just isn't worth risking my job and license. The M.D. are the ones that write the orders not me. It's just really frustrating, when you have been a nurse for many years your gut can tell you things that a test never will!!!!

We had a frequent flyer in all the time for headaches, abdominal pain..... At lest 3 times a month always asking for that drug that starts with a d cant really remeber the name but it works really good. Untill one day she came in and had a massive MI, thankfully she survived and after a weel upstarirs, we haven't seen her back.

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Ivanabee,

We had a husband and wife that was the same way, the husband suffered a major MI and she a major OD. Thankfully, both survived and like you, we haven't seen them back.

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Specializes in Med Surg.

What is it about these doctors that write it Q 2??????

I work nights and these people wake up EVERY 2 hours for this SEVERE pain.... right..... you were sound asleep just a few minutes ago....

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I have to admit I have a problem giving Q 2hr Dilaudid. Given that it is a powerful narcotic, to me that means something else is going. If it is physical, then pain is not being properly controlled. If it is psychological, they don't NEED Dilaudid, they need a psych consult.

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You know what really chaps my hide?

When people freak out about the druggies and then end up taking the druggies' sins out on the actual sick people.

Can we please remember that not EVERYONE is a drug seeker and some people really do have pain that isn't controlled?

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I am allergic to dilaudid, morphine, and oxycodone. Demoral is my "drug of choice" I always ask for it for after my surgeries because I have learned that I freak out when waking up and demoral seems to conteract that and calm me down.

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I do want to make it clear that I am not against giving people pain med...I administer dilaudid every day to people who are really hurting.

But this is what really gets me..we have the patients that we know are drug seekers..their tox screens are positive for illegal drugs when they come in. They are so stoned they ring the call light constantly asking for pain medicine because they can't remember that they just had it. All of their workups (yes we do the same tests over and over every time they come in) are negative.

To me this signals that this person has a real drug problem....I feel that instead of helping these people we are doing more harm by feeding into their addiction.

When the heck did it become wrong to sit down with a patient and say "Hey, it appears to me that you have a drug addiction issue and you need help."

We don't do this! Are we afraid of offending someone? What if the one time that you offer help.... that person realizes that maybe someone cares after all and they decide it is time to change their life.

It is my feeling that by giving the known drug seekers Dilaudid every 2 hours we are no better than the pusher on the street. Just because it is legal for us to do it doesn't make it right!

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Whenever patients do that I always wonder what drugs they have at home.

I've had patients tell me outright that they have better drugs at home....and/or that they can get better drugs on the street.

I tell them that they should have considered that before "checking in".

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I am allergic to dilaudid, morphine, and oxycodone. Demoral is my "drug of choice" I always ask for it for after my surgeries because I have learned that I freak out when waking up and demoral seems to conteract that and calm me down.

You might start having a problem getting that particular drug. Our hospital no longer carries it as formulary, only as a last-resort med when the patient is allergic to EVERY other option possible. This is the way in LOTS of hospitals now...something about how the toxic effects of this med outweigh the benefits, and docs don't want to be caught prescribing it. And pharmacy has told our nurses that if they give it without questioning exactly why something else (anything else) could be given, we could be hung out with the doc for the consequences.

Since this directive came down, we've found other options, none of which are Demerol, and all of which seemed to work.

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