I've started working prn at a new hospital in a different county from my previous job. At my full time job (a med surg floor) we see our share of drug seekers. We may have one drug seeker as a patient every few shifts. They almost always have another underlying medical problem. But at my new job the amount of drug seekers is absolutely ridiculous. I will have 1-2 drug seeking patients every shift. And yes they usually have underlying medical problems. But seriously 8mg of morphine and 25mg of phenergan IV every 3 hours for a patient with DM? Where is your pain? Your abdomen? Well you're eating soup and drinking coffee so it must not be too bad. I guess because this hospital is the only hospital in that particular area we see more drug seekers than my other job. At my full time job the hospital is 1 of 2 major hospitals in that particular county.
I have never given narcotics like I am having to give at my new job. I have patients who are getting Morphine 4mg IV every 2 hours for SBO and this has been going on for over a week!! And you wonder why your bowels haven't started moving????? I had a patient 2 nights ago call for her morphine and phenergan and when I got down to her room she was snoring!! Then when she woke up 2 hours later she was furious that I didn't give her the medicine while she was sleeping?
These people aren't fooling me? How do they fool their doctors so easily? Or do their doctors just not care? The same people come into the hospital over and over every few weeks with the same issues and spend their entire admission higher than a kite. I know addiction is a disease but when doctors are enabling the disease they surely won't get better!!!
And the truely scary part is this hospital is full of new grads... These new grads don't even blink an eye about giving large amounts of narcs over and over every 2 hours.... This is a serious accident waiting to happen......
I think the pendulum will swing back the other way. Maybe not in our lifetime, but it will. I think part of the issue is the idea that pain has historically been undertreated and mismanaged, so there is this movement to accept the patient's report of pain at face value. That's all well and good and I think all of us in healthcare agree that pain needs to be treated appropriately, but there has to be some balance. There has to be some accountability on the part of the patient to cooperate with the treatment plan; to do their part in addressing the root cause of the pain (whether physical or emotional, psychological, or spiritual) rather than just being passive receivers of insane amounts of narcotics without anyone ever questioning whether this is appropriate pain management.
I see the pendulum moving a bit more in that direction, with PCPs making medication agreement contracts with their patients and pain management clinics using multifaceted approaches. But unfortunately what happens in the hospital system is a fragmentation of care, so that if the person presents to the ED or is admitted to the hospital, their medication agreements don't seem to apply.
I work in an area with a great deal of pain meds, especially with spine patients. Whenever I'm giving a large dose of narcotics, etc, I always look back in the computer charting to see what has been given and how much and how the patient's VS were before and after. When I have someone who is demanding narcs but can't stay awake for the conversation, I hold them and document document document. When I do have to give morphine, phenergan and ativan all to the same pt who is still lucid, I keep them on pulse ox and keep the alarms ON. Its nerve wracking. I actually had a pt on a dilaudid PCA a while back whose 4 hr limit was 16 mg. And he had slow release PO morphine on top of that.
I actually had a pt on a dilaudid PCA a while back whose 4 hr limit was 16 mg. And he had slow release PO morphine on top of that.
This makes my jaw drop! How in the world was this patient able to keep hitting the button while getting 16mg of Dilaudid in 4 hrs? And PO Morphine? I'm sorry but I think this is excessive and you bet I'd be documenting my butt off on this one.
I work in the ER and we have drug seekers like crazy. Our docs are pretty good and won't give narcotics out to just anyone.
Specializes in General adult inpatient psychiatry.
I've started working prn at a new hospital in a different county from my previous job. At my full time job (a med surg floor) we see our share of drug seekers. We may have one drug seeker as a patient every few shifts. They almost always have another underlying medical problem. But at my new job the amount of drug seekers is absolutely ridiculous. I will have 1-2 drug seeking patients every shift. And yes they usually have underlying medical problems. But seriously 8mg of morphine and 25mg of phenergan IV every 3 hours for a patient with DM? Where is your pain? Your abdomen? Well you're eating soup and drinking coffee so it must not be too bad. I guess because this hospital is the only hospital in that particular area we see more drug seekers than my other job. At my full time job the hospital is 1 of 2 major hospitals in that particular county.
I have never given narcotics like I am having to give at my new job. I have patients who are getting Morphine 4mg IV every 2 hours for SBO and this has been going on for over a week!! And you wonder why your bowels haven't started moving????? I had a patient 2 nights ago call for her morphine and phenergan and when I got down to her room she was snoring!! Then when she woke up 2 hours later she was furious that I didn't give her the medicine while she was sleeping?
These people aren't fooling me? How do they fool their doctors so easily? Or do their doctors just not care? The same people come into the hospital over and over every few weeks with the same issues and spend their entire admission higher than a kite. I know addiction is a disease but when doctors are enabling the disease they surely won't get better!!!
And the truely scary part is this hospital is full of new grads... These new grads don't even blink an eye about giving large amounts of narcs over and over every 2 hours.... This is a serious accident waiting to happen......
We had a patient managed to convince the medical attending that he needed to be on the ETOH withdrawal protocol/CIWA scale and he had only been out of jail for 3 days, hardly enough time to drink enough ETOH daily to go through withdrawal. Patients can be very manipulative when it comes to getting what they want. Of course, the doc immediately D/C'ed the order once she realized that she'd been duped but some docs are more willing to give out things like Percocet for DJD or other complaints and it's because pts know that these are things they can easily get in the hospital and less readily if they were on the street.
I have more of a problem getting enough narcotics. Working peds, the docs are so used to tiny doses that when you get a 200 pound 17 year old, it's hard to convince a doc that 1.5 mg of morphine every 4 hours isn't going to cut it.
My attitude when I've done adults was always, I've got an order, they say they're in pain, I'm not going to cure their addictions, and I know where the narcan is. It's easier to go with the flow. And quicker to just give the narcs and get back to my other patients than to fight with them. My biggest pet peeve is if the doc decides to cut the narcs without telling the patient. Do NOT make ME the bad guy here!
Specializes in Med/Surg and Critical Care Stepdown.
We will stop seeing drug seekers when hospitals ban together with a policy that states pain will be treated with NON-NARCOTIC medications (ie., ibuprophen and Tylenol) until an underlying cause can be determined. Suggest it to the docs - sometimes they'll agree! I know of one hospital that actually instituted a similar policy, having frequent flyers sign a 'contract'. It's cut down on the abusers:D
Doc's can actually get sued for not treating pain. And remember "pain" is wha tthe patient says it is. Not that it's right but one of our doc's said they are backed into a corner when this happens.
When I was a new grad, someone very succinctly told me, "When you're on trial and the patient is accusing you of leaving them in pain, there's no way you can look like the good guy unless you have a darned good reason." It really ticks me off to see drug seekers who ruin it for the people who really need it.
The bane to my existence is patients who have had their pain or anxiety meds reduced or d/c'd. They will get mad, blame you for being rude, take it out on you, and make unreasonable demands like calling the doctor at 3 am when it's not an emergency.
I do agree that doctors and other healthcare staff are stuck between a rock and a hard place when it comes to pain management. Hehe, I love the NPO and non-narc until source discovered tactic! I also love it when docs make those meds IM!
One of the things that we are being encouraged to do in long term care and rehab is to attempt non-pharm. alternatives to reduce narcotic use. Most of our pts. are very open to this--and in rehab a combination of methods are common.
However, I recently started at a TCU that has been open since July. The vast majority of their floor nurses are new grads. Several of the supervisors are recent grads with less than a year of experience. Most have zero acute care experience. There are three nurses that I've met that have more experience than I do, and I've been a nurse for two years.
Most of these new nurses are so focused on the "Pain is what the pt. says." and lack the experience at therapeutic interactions that they are unable to attempt non pharm. interventions. They are pretty chicken to talk to the MDs, and make no attempt to try and educate on medication use, relaxation techniques, or even talking to therapy for possible PT interventions such as ultrasound or diathermy...
I am working NOCs, have little contact with family (except for one family) and have one pt. that is using the max dose of vicodin every day. He had trouble with oxycontin (bad side effects) so the GNP d/c it and went to PRN vicodin instead. Last night he asked fro two at 11pm and by 2:30am wanted two more. Had to have the discussion about the max dose in 24 hours...offered repositioning, massage, heat, and ice...and got my head bit off. Yah think I've got someone with pain or a drug seeker on my hands....?
I put in a note to the MD and GNP to review the medications and the heavy narcotic use. This guy is 3 months past his surgery! Why not try a higher dose of neurontin, scheduled meds, or something without all the tylenol?
I've started working prn at a new hospital in a different county from my previous job. At my full time job (a med surg floor) we see our share of drug seekers. We may have one drug seeker as a patient every few shifts. They almost always have another underlying medical problem. But at my new job the amount of drug seekers is absolutely ridiculous. I will have 1-2 drug seeking patients every shift. And yes they usually have underlying medical problems. But seriously 8mg of morphine and 25mg of phenergan IV every 3 hours for a patient with DM? Where is your pain? Your abdomen? Well you're eating soup and drinking coffee so it must not be too bad. I guess because this hospital is the only hospital in that particular area we see more drug seekers than my other job. At my full time job the hospital is 1 of 2 major hospitals in that particular county.
I have never given narcotics like I am having to give at my new job. I have patients who are getting Morphine 4mg IV every 2 hours for SBO and this has been going on for over a week!! And you wonder why your bowels haven't started moving????? I had a patient 2 nights ago call for her morphine and phenergan and when I got down to her room she was snoring!! Then when she woke up 2 hours later she was furious that I didn't give her the medicine while she was sleeping?
These people aren't fooling me? How do they fool their doctors so easily? Or do their doctors just not care? The same people come into the hospital over and over every few weeks with the same issues and spend their entire admission higher than a kite. I know addiction is a disease but when doctors are enabling the disease they surely won't get better!!!
And the truely scary part is this hospital is full of new grads... These new grads don't even blink an eye about giving large amounts of narcs over and over every 2 hours.... This is a serious accident waiting to happen......
I am shocked at the lack of compassion shown by some of the nurses here. I have been in agonizing pain and had a nurse not give me my narcotics just because I was eating a burrito and texting. You can't know what I am feeling. When I have one of my migrainse 4 mg of dilaudid barely scratches the surface. Thank goodness for Dilaudid, it is one of the few drugs I am not allergic to.
I hope none of you go through the hell I experienced.
Virgo_RN, BSN, RN
3,543 Posts
I think the pendulum will swing back the other way. Maybe not in our lifetime, but it will. I think part of the issue is the idea that pain has historically been undertreated and mismanaged, so there is this movement to accept the patient's report of pain at face value. That's all well and good and I think all of us in healthcare agree that pain needs to be treated appropriately, but there has to be some balance. There has to be some accountability on the part of the patient to cooperate with the treatment plan; to do their part in addressing the root cause of the pain (whether physical or emotional, psychological, or spiritual) rather than just being passive receivers of insane amounts of narcotics without anyone ever questioning whether this is appropriate pain management.
I see the pendulum moving a bit more in that direction, with PCPs making medication agreement contracts with their patients and pain management clinics using multifaceted approaches. But unfortunately what happens in the hospital system is a fragmentation of care, so that if the person presents to the ED or is admitted to the hospital, their medication agreements don't seem to apply.