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 like to take the approach that pain is subjective, therefore you never do know for 100 percent truth. Otherwiswe I would have a tough time sleeping at night. Sure, we all know dilaudid, phenergan and then benadryl cocktail for the itching is ridiculous, but it isn't our place to refuse necessarily. There are many steps that can be taken to attempt to minimize the amount of narcotics given to your patients, but the most helpful for me, is to firmly let them know that patients who get to leave in his or her condition will need to be on PO prns before discharge. Sometimes being in a hospital annoys them, however, some don't care because they are getting what they want. Also discussing the entire situation with the physician will help, as they will titrate the dose down, or dc it and then it will be impossible for the patient to get them, maybe only some X1 orders.
I totally agree with you and have seen a lot at my hospital too, patients with saline locks in their ankles because all of their veins are gone....but in the end pain is subjective, and if you have tried every other alternative method, and it doesn't work, don't worry about it, it needs to fully involve the patient acknowledging a problem before you can begin to cure addiction.
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
So you have to prove that you need the pain medication first?! Wow! I've known people who had legitimate issues which caused them severe pain that took days and weeks to diagnose as the docs ruled out one cause after another. So now folks are going to be forced to wait around in pain until the docs are satisfied they are truly deserving of pain relief? Interesting. How does that work again and is this policy applied to everyone? For instance, someone walks into ER, c/o pain but plain films show nothing. ER docs say "go home deadbeat and take some Tylenol if you're hurting so bad. Your PCP can set you up for a CT scan later if you insist". So when the CT later shows a fracture do you then say "oops, my bad".
Docs know who the seekers are as well as we do. They know they will get no rest until they give what the pt. wants. At least order a PCA so I don't have to go in every 4 hours and hear all the drama.
So you have to prove that you need the pain medication first?! Wow! I've known people who had legitimate issues which caused them severe pain that took days and weeks to diagnose as the docs ruled out one cause after another. So now folks are going to be forced to wait around in pain until the docs are satisfied they are truly deserving of pain relief? Interesting. How does that work again and is this policy applied to everyone? For instance, someone walks into ER, c/o pain but plain films show nothing. ER docs say "go home deadbeat and take some Tylenol if you're hurting so bad. Your PCP can set you up for a CT scan later if you insist". So when the CT later shows a fracture do you then say "oops, my bad".
Yea I agree that a policy like that is inappropriate and would never work. Like I said earlier I do not believe in withholding pain meds for people who are truly in pain. Yes pain is subjective and maybe my patient who states that they are having a panic attack yet shows no signs or panic... maybe they are panicking on the inside... who am I to judge? Yes maybe the lady eating, watching TV, and talking on the phone truly does have abd pain 25/10...... I medicate them as ordered... However it is frustrating when my 6 other patients need me in their room but instead I'm having to prove to the 35 yr old drug seeker that they are only allowed to have Morphine 8mg ever 3 hours and YES they do have to wait 45 more minutes and NO I cannot give it early.
I guess for my hospital there is no main demographic for seekers, because I tried to think back on my favorites and there really was no commonality. It is frustrating especially when you thought your patient was a normal patient with legitimate concerns/issues until they reveal that they really like dilaudid and want you to push it fast so they get a rush. No need to dilute it either! It makes me feel used.
But what I want to know is where are these people going for their prescriptions? Any doc I've ever gone too is pretty reluctant to give any pain meds? I would just like a prn prescription for my joint and foot pain probably once a week (otc takes care of it most of the time). But maybe its because I'm a nurse? I don't know...it sucks though.
And another thing, I want to know who are the nurses who give it early? Burns me up when I hear well other nurses have done it. Really, well those other nurses were not me (let alone violating policy and board of nursing standards but I wouldn't mention that to a patient).
I will say this. I recently had to find out the half life of dilaudid for a nursing school question. I googled it. I for whatever reason found a forum for people using pain clinics and doctors, and this person posted that they took and UNGODLY amount of dilaudid on top of extra methadone, and obviously they made it because they were concerned that their levels would be way off for their pain clinic urinalysis. LOL.
And another thing, I want to know who are the nurses who give it early? Burns me up when I hear well other nurses have done it.
I'm sure all the other nurses are letting Johnny jump off of a bridge too. :) Like we don't have a record of when it was given when they start making up stuff like that. Did their parents believe them when they told them "all the other kids are doing it!"
Like I said earlier I do not believe in withholding pain meds for people who are truly in pain. Yes pain is subjective and maybe my patient who states that they are having a panic attack yet shows no signs or panic... maybe they are panicking on the inside... who am I to judge? Yes maybe the lady eating, watching TV, and talking on the phone truly does have abd pain 25/10...... I medicate them as ordered... However it is frustrating when my 6 other patients need me in their room but instead I'm having to prove to the 35 yr old drug seeker that they are only allowed to have Morphine 8mg ever 3 hours and YES they do have to wait 45 more minutes and NO I cannot give it early.
I know exactly what you mean. I had a patient scream at me because I think I chuckled (my bad!!) when he rated his pain level at infinity, though he had been snoozing a few moments earlier. When we get the drug seekers, they're usually "frequent flyers" and the docs already know their game. I've had PCA's set at dilaudid 1 mg with 15 minute lockout, and the patient watches the clock like a hawk so he doesn't miss a dose, God forbid!!
Like I said earlier I do not believe in withholding pain meds for people who are truly in pain. Yes pain is subjective and maybe my patient who states that they are having a panic attack yet shows no signs or panic... maybe they are panicking on the inside... who am I to judge? Yes maybe the lady eating, watching TV, and talking on the phone truly does have abd pain 25/10...... I medicate them as ordered... However it is frustrating when my 6 other patients need me in their room but instead I'm having to prove to the 35 yr old drug seeker that they are only allowed to have Morphine 8mg ever 3 hours and YES they do have to wait 45 more minutes and NO I cannot give it early.
The thread is about how drug seekers manipulate everyone around them to get what they want. To get attention. And to take attention away from every other patient in the hospital. Particularly the ones who are truly in pain and are sick. And how physicians don't have the guts to stand up to them b/c heaven forbid they lose a customer.
Like a few nights ago when my patient claimed they were having a panic attack. Yet their VS were within normal limits and they were sitting there watching TV with their mouth hanging open and their head bobbing back half asleep. I'm sorry I just cannot believe that she was truly in a panicked state. The patient was making a sorry attempt to manipulate me into calling her doctor at 11pm in order to get an extra dose of ativan.... On top of the morphine and phenergan she was receiving Q 3 hours and the Valium Q 6hrs.....
Can you honestly tell me that you believe that every patient that claims they are in pain is truly in pain? Or anxious or whatever? GMAB
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.
We have a lot of chronic pain patients, and they are often on very high doses of pain meds. This was the highest I've seen. He was totally lucid and waking up to push the button, but I did park myself very close to his room when I was charting, and I went in there a lot to make sure his pulse ox monitor was working.
I empathize with your concern. I work on a med-surg unit and believe me it does get frustrating at times when you constantly have a revolving door of pain seeking patients. I understand that you do not know truly know if someone is telling the truth about their pain, but when you have patients who are receiving Dilaudid 2-4mg every 2 hours prn and are setting their alarm clocks so that they do not miss a dose it's sometimes difficult for me to believe that these patients are truly in the pain that they say they are in because I believe that if you are truly in pain then you are not going to set the alarm on your cellphone to go off, then call the nurse for pain meds, and fall back asleep in the process of talking to the nurse over the call bell asking for the meds, maybe I am wrong for feeling this way but we really need to stop feeding drug habits. Whenever foreign nurses come in from other countries they are often surprised at the amount of narcotics that we give here in the states, and i can honestly say I really cant blame them for feeling that way
RNsharkinaj
24 Posts
I like to take the approach that pain is subjective, therefore you never do know for 100 percent truth. Otherwiswe I would have a tough time sleeping at night. Sure, we all know dilaudid, phenergan and then benadryl cocktail for the itching is ridiculous, but it isn't our place to refuse necessarily. There are many steps that can be taken to attempt to minimize the amount of narcotics given to your patients, but the most helpful for me, is to firmly let them know that patients who get to leave in his or her condition will need to be on PO prns before discharge. Sometimes being in a hospital annoys them, however, some don't care because they are getting what they want. Also discussing the entire situation with the physician will help, as they will titrate the dose down, or dc it and then it will be impossible for the patient to get them, maybe only some X1 orders.
I totally agree with you and have seen a lot at my hospital too, patients with saline locks in their ankles because all of their veins are gone....but in the end pain is subjective, and if you have tried every other alternative method, and it doesn't work, don't worry about it, it needs to fully involve the patient acknowledging a problem before you can begin to cure addiction.