When patients lie about rides.....

[TazziRN]

I had a pt this morning, rib pain after a play wrestling match a few days ago. He drove himself to the ER and rated his pain at 11/10. I got an order for Vicodin #2, and before I let him have it I had him call for a ride. I spoke to the friend, whose wife is a resident in our LTC unit, he said he would be with her and would await our phone call. I medicated. When he was ready for discharge I was off the unit and a coworker discharged him. He told her that he would just walk down to the LTC and get his friend to take him home. When I came back and found that out I cringed. (Coworker is new to ER, was a PACU nurse.) When I explained how it should have been done, she said "But he said he was going to go over to LTC for his ride home."

About a hour later a man knocks on the ER door. It's the friend wondering how much longer it's going to be because he's ready to go home. My cringe was accompanied by a silent moan. When I explained what had happened he shook his head and said "His truck's not in the parking lot and he never came to get me."

I told the friend to "beat up the pt's other side when you find him"!

[MomNRN, BSN, RN]

I liked the answer "ThisEDRocks" had.

I think from now on I will be adding a sentence to my discharge instructions that states I advised pt's not to drive and they agreed to this advisement. When they sign the discharge instructions, they are in-fact agreeing.

I don't have time to baby-sit. I tell pt's ad-nauseaum about what they need to do - if they choose to ignore it, that is their problem and my A is covered.

[linda535]

My favorite urgent care story was a pt medicated with Demerol and Phenergan and supposedly waiting for a ride in the lobby. Reception called us to tell us we must have "cured him" because he was seen sprinting across the parking lot to his car and drove off. I agree that with litigation rampant now, our best bet is documentation. And with this type of pt, we can place electronic notes to prevent docs from giving narcs in the office or prescibing any for them in the future.

[damarystx]

I used to work in an immediate care and after having such an incident we made it policy that if a patient was to recieve narcs they had to remove their clothing and be in a gown, we would then take their clothing to the nurses station and place it in a bag with a patient sticker on it. The patient would get their clothes back when their ride showed up and actually came to the room. In one case where the patient had walked to the IC we called a cab and then watched the client actually get into the cab, so he wouldn't end up getting hit by a car or causing an accident on the VERY busy road we were located on.

[lunabellevoix]

I always make another person co-sign the d/c paperwork as "driver". This isn't required where I work, but I do it anyway. If they say they are taking a cab, I hold onto their pain Rx until the cab driver comes in and signs. Works like a charm.

[TazziRN, RN]

I also hold paperwork and scripts until I see the driver, or on discharge of ANY pt. And we are liable if the pt drives, because they are still on hospital property when they leave. Something could happen in the parking lot.

I like the idea of having the driver sign too....I think I'll start doing that.

I actually did that as a patient once

So did I but here's why I'm so adamant about not letting it happen: I had a scope done several years ago and my dad was my driver. I got 50mg of Demerol and 15 of Versed IVP for the procedure. My dad took me home to my apartment. I was bored so I decided to drive to the store for a video. I thought I was fine. On the drive I nearly hit a couple of cars, bumped into a cart parking rail while parking, and the tires brushed up against the curb when I turned the corner into my complex. Both of them. When I sobered up and realized what I had done, what had happened, and what could have happened, my blood ran cold.

No, it would not have been the endoscopy center's fault if I had caused injury, but if I had done that stuff in their parking lot, they would have been liable. Therefore, NOBODY who receives narcs or any other sedating drug is discharged until I see a driver and the driver understands that he is to take the pt ALL THE WAY HOME, not just to the pt's car.

[lunabellevoix]

Yeah, I just make an extra line and write "driver" under it. I'm not certain how legally binding that is, but it most likely looks a lot better than nothing if something were to happen. I wonder if it then places the liability in the person who signed as driver's hands? It sure gives the defense something to hammer them about if it went to court though, huh? -Dianne

[ERnurse1139]

I work night shift in a small rural hospital with a free ambulance service for those without private insurance. We have patients who come by ambulance for minor complaints, using the ambulance as a one-way taxi service to the ER, also bypassing the waiting room! These patients have no vehicle, no way home, and usually can't get ahold of anyone. The taxi only runs until 3am and patients claim (and I don't doubt) that they have no money for a taxi. Then there is, of course, the patients who were "dropped off and will call their ride when it's time to leave," and then the ride can't be reached. To withhold narcotics until a patient has a ride in the department would tie up the room, causing further delays to patients in the waiting room who need to be seen.

This is such a common problem that we routinely call dispatch to have a cop drive the medicated patients home! This seems crazy to me, and is a pet peeve of mine (and the cops). The cops should be patrolling the roads and available to respond to calls, not playing taxi. Maybe I'm heartless, but I feel patients who either lie about having a ride, or who's ride has become unavailable/unreachable, or who came by ambulance for non-emergent complaints should just have to wait in the lobby until morning when they can get ahold of somebody. Of course the ones who drove to the ER probably would sneak out, and others would try to walk home in the dark, in which case our documentation would have to be adequate.

I haven't voiced this opinion at my work because it does sound heartless and I'm afraid it would make me look bad to the higher-ups who are all about patient satisfaction and caring about the patient. I'm curious to know what others think:

:confused:Am I heartless and mean to think this way? Or is the practice of using the cops to transport these people home as crazy as I think it is?

Also, do your ED's use the police to transport patients home? Any suggestions?

[babynurselsa, RN]

Our local police force would get a big laugh if I called them to give someone a ride home.

[lunabellevoix]

Just hearing your dilemma makes ME ill, you poor thing. My hospital used to be non-profit and gave pt's "cab vouchers" to get home. Maybe you can suggest your hospital make a deal with one certain cab company for a break in fees, in exchange for long-term use of their service, and include it in the pt's bill - or even write the cab voucher off. We have stopped this practice because we are for profit now, and it was being abused. That may be an option? People never cease to amaze me, though. Our Paramedics tell me people call an ambulance just to get a RIDE to the city! They sign out AMA before any tx - makes me sick. Personally, since pain is not really an emergency, I would refuse to give them narcs at all until someone was called and was there to drive - and sign as driver (not sure the legalities of that, but it has never failed to produce a driver within a half hour, either). I usually move them into a hall bed to wait and also to free their room up. We have one MD on nights who will make non-emergent ambulance pt's be sent out to triage to be assessed, then wait in the waiting room like everyone else. Personally, I think it's great.

To answer your question about heartlessness...no, it's not heartless. If you let these people run you and abuse your services, you will burn out...quickly. Further, I think it's heartless of THEM to take an ambulance just because they know they will get seen more quickly, when they must know there are people sicker than them waiting. I have zero sympathy for non-emergents taking ambulances. Heartless? Maybe. Realistic? Yes.

[lunabellevoix]

PS - I agree with "babynurselsa", cops in my town would laugh their butts off if I asked them to drive a patient home for that reason. Surprised your force allows it.

[ERnurse1139]

I think our police force thinks (or maybe has been told by the hospital?) that they have to do this because the alternative is leave people stranded, either hanging out at the hospital or trying to drive or walk home which endangers innocent others. My feeling is, let them hang out at the hospital all night then. If this is their only option, I'm sure most of them would be able to find a ride pretty quickly. But this is what I thought might be perceived as heartless. Thanks for your input. It's good to hear that I'm not the only one who thinks it's ridiculous for cops to take patients home!

[babynurselsa, RN]

Well that and I only know one place any of the police I know would give a ride to.............

My rule is no driver no med. It is the policy of any place I have worked.