I was orienting a new nurse over the weekend and she got to experience her first drug seeking patient. Well, the patient did have some documented back issues, but the pain regimen she was given inpatient enough to put down a horse. There is
no way she was getting that much pain medicine at home, so the tolerance argument is invalid. 2 mg IV dilaudid Q4 plus 40mg Oxy SRQ12 plus 30 mg oxycodone prn Q4, plus 2 percocet Q4 prn is not a regimen she was getting at home. And it's HIGHLY unlikely that with all those narcs that a pain of 9 and 10 will be present in your head, then your back, then your leg. So I told my orientee all about the K.D. Lang lookalike incident
http://codebabe.blogspot.com/2011/11/you-aint-foolin-anyone-k-d-lang.html and the orientee came back from giving the pt dilaudid and was telling me all about how she talked to the patient for a while and that she thinks her pain is really that bad etc. then we hear a beeping coming from the room. Screen on the IV pump says "Door Open" the IV tubing was wrapped around the pt's hand, around the pole.. it was obvious she was tampering with it. Why? I'm thinking first she tried squeezing the tubing to make the narcs go through faster, then she was trying to pull the tubing out from the IV pump so she can run the IV fluids quickly so she gets a rush from the dilaudid that way. I fixed all the tubing, and engaged the lockout feature on the pump. When I walked out with the orientee she said "I hope you know that was NOT how the tubing looked when I left that room 2 minutes ago.." I said, "Oh, I know it wasn't. I'm shocked she didn't pull something like this sooner." Orientee looked at me in wonder and said "You really know your shit." YES, YES I DO. lol
So, let's sum up what to remember about drug seeking patients:
1. They will always call for pain meds early. Don't give them early, not even 15 minutes-- over time if you consistently give a pain med early, eventually the patient will be getting more than the Dr. ordered in a given 24 hour period. This is especially dangerous with narcs.
2. Their pain level is always 7 or higher. Even 10 minutes after a dose.
3. They like to sleep a lot. When they are not sleeping, they are asking for more pain meds.
4. They are manipulative. They will change stories about where pain is located (documenting all they say is key and helps the Dr. piece together a true picture of what is going on) They also can be very complimentary of you and the hospital in general in an effort to make you "like" them and want to continue making them happy.
5. They think you are stupid.
6. They will sometimes ask you to push IV meds faster than you should. (2-3 minutes IVP is standard for narcs.. or any med, really. The only med I might push faster is zofran for nausea if someone is violently retching)
7. They will make strange requests. (like asking for 10 ml syringes full of normal saline. Those are to remain locked up at all times. Substances can be dissolved and injected through IVs with those; don't fall for it.)
8. If they do make a strange request, listen to your gut and just don't agree to doing it.Even if you can't give a good reason why not.
9. They will tamper with everything possible
10. They will risk their safety- and as a result, your license in the bat of an eye. WATCH THEM AND DOCUMENT EVERYTHING
There you have it. The drug seeker.
I had a serious opiate addiction for a number of years, although I've been sober for over four years now. The things you mentioned don't really encapsulate drug seekers, the bottom line is, you'll be fortunate to catch 1 in 10. In doing so, you'll likely end up mistreating legit patients. When I used to engage in this behavior, I never once got turned away from an ER or doctors office without getting what I wanted. Of course, this was before states starting the monitoring programs, I have not engaged in this type of behavior for nearly 10 years.
ReplyDeleteI think the only real way to ascertain if someone is drug seeking or not is to use a PMP. Most states have them, a doctor or nurse should be able to look up a patients history easily. If the patient is getting drugs from multiple sources, there is no need to rely on your wits (or lack thereof) Any drug addict worth his salt is always going to be one step ahead of any clinician. Of course, this only applies to patients who abuse the system, some only pop into the ER when they run out of street pills or heroin.
In short, playing the guessing game, which is really what you're doing, often times ends up causing more problems than it solves. If your state does not have a PMP, you need to push for one. It's the only reliable way to weed out the drug addicts/seekers. Of course, being a nurse I know you'll want to treat everyone with respect, addict or not. Addiction is a disease and if you suspect someone is an addict, you should make sure that they have viable treatment options. If they refuse, well hey, at least you did your part.
Good luck in your nursing career.
Thank you for the well thought out response! I appreciate the feedback. Quite honestly, if someone has an addiction and is trying to manipulate or "trick" clinicians into prescribing one drug or another, I don't feel that's any of my business. That's all on the Dr, as far as I'm concerned. My issue is with once they are prescribed, how the patient behaves re: dose times, how fast to push the med, etc. And you are correct in that I will always treat my patients with respect and I will even sympathize with their addiction and will (and have) talk to them about their options to get help. This is especially true when I see a young person just abusing the hell out of their perfectly healthy body while I watch someone struggling to live in the very next room. What this post spoke more to was the very manipulative drug seeker in the inpatient setting who adds an incredibly huge amount to stress into my shift and negatively impacts the care of non manipulative patients and at times even treats me disrespectfully. I'm not sure if our hospital uses PMP (only the docs use it, if so).. it might, but things get tricky for the docs when you have a person who was in an MVA and has actual pain and is on a narcotic regimen outpatient-- almost always those pts end up with as needed IV pain meds for breakthrough pain. (which then get asked for around the clock) I know the tone of this entry was very harsh, but I tend to write when emotional and I get VERY upset when I have patients that cause issues for me or my other patients. Thanks again for reading/responding. :)
ReplyDeleteAlso wanted to add, congratulations on beating your addiction. I know it's something you still must struggle with every day and I think it's wonderful you continue to keep winning.♥
ReplyDeleteThis is really good information, but because of these people that just want to get high, people like me get caught up and are always looked at suspiciously. It's unnerving to say the least to the point of paranoia. I have lupus and doctors and nurses are always giving me the eye...even though I walk with a cane, walker, and use a wheelchair and have severe arthritis, I'm told that I don't need pain management and thrown muscle relaxers when they do nothing for me. It makes me so freaking angry. Some of us are really in pain!!
ReplyDeleteSuper, I am sorry that has been your experience. (re: evil eye) Please understand that the VAST majority of patients I medicate, I absolutely do so because I believe they genuinely have pain- and even if they DON'T have pain, it's really none of my business if the med is due and the Dr. ordered it. It's also absolutely disgraceful for a healthcare professional to come across as the slightest bit judgmental/suspicious toward someone who says they are experiencing pain.(even in the woman described in this entry I can tell you I never even hinted that I doubted her, it's not my role to judge or accuse anyone) That really sucks that you don't have a pain management dr who has been able to help you. I hope you are able to find relief!
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ReplyDeleteI'm sorry to sound so harsh but it's infuriating that a few bad eggs ruin everything for everyone else. I'm in a town full of college kids and they must be abusing because now, bones could be broken and sticking through the skin and you'll be put through the ringer to get any medication. Now, they will prescribe xanax and/or SSRIs if you just say you're kinda sad. In my opinion, those are just as harmful as narcotics! And we don't know the long term effects. Anyway, I am sure you are a good nurse...but this is frustrating and there was a page on facebook for nurses where they were making fun of patients in pain and saying most patients should just get a placebo shot and make them think they're getting drugs - then they'll get lost. What?! What happened to Do No Harm? It really shook my faith in the nursing community.
ReplyDeleteAnother troubling trend I've seen is walk in clinics refusing to treat pain now. A good friend of mine suffers from debilitating migraines and they can't be predicted and once they arrive, it takes an arsenal of medication to get her any relief. And she is 5'2 and weighs about 95 pounds. She went over to the walk-in doctor and this foreign nurse looked at her chart and saw that she had been in there a lot for pain and practically RAN down the hall to tell the doctor that there was a possible drug seeker there. The doctor believed the nurse and sent my friend away, saying they don't treat chronic pain. She could barely even drive! She could have gotten in a traffic accident or died due to that shitty nurse interfering and pushing her own agenda on the doctor. What in the world? I don't know why doctors or nurses care so much anyway if a patient is taking pain medication. And pharmacists are nightmares, too. I hope I never get a pain condition. I just know my little friend goes through hell and it's not her fault she has migraines!
Hi there! I am not an addict nor a nurse, but I thought your post was really funny. I have a few very close friends who are nurses and love their jobs-- A job that is very easy to take a stab at with an anonymous post..ahem! I am really sorry that your humorous post had to be tainted by crabby people who don't have a life and need more than just pain medication! Your patience with these negative and discouraging responses speaks volumes about your character. I am also an ENFP, so I understand how important your intuition is in kicking ass at your job. Keep up the good work and entertaining writing. I enjoyed it :)
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