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.
