The over-prescription of narcotics in this country is an epidemic. Here are a few tips to help guide you through a shift with a drug-seeking patient.
Explain the medicines and their side effects in detailRight at the start of the shift, explain that a serious and common side effect of opiate pain medications is sedation that can compromise respiratory function as well as lower BP to dangerous levels. Furthermore, explain that if this occurs, that the patient will not receive any of these types of pain medications as it is dangerous, and that they will have to wait until their vitals are more stable.
Write the scheduled times on the whiteboardMost hospitals have whiteboards where you can write important information, and most even have a section specifically for pain medication information. Write the name of the drug and how often it can be given, including a last time given and a next time available. This will hopefully reduce callouts from patients requesting meds early, and if not, simply direct them to the whiteboard.
Never give pain medication earlyOftentimes, drug-seeking patients will ask for you to give their pain meds ahead of schedule. Your hospital may have a policy of giving scheduled medications an hour early or late and still being considered on time. Realize that this rule NEVER applies to pain medicine or other PRN medications.
If everyone consistently gave a med 1 hour early, the patient would likely end up receiving additional and potentially unsafe doses of the medication.
Do not alternate between different pain medsUnless specifically told otherwise in the orders, you should not be switching between different pain medicines and giving them concurrently. A lot of times patients will have IV pain meds ordered for severe pain from a scale of 7-10, PO main medicine for a medium pain level of 4-6, and then something like Tylenol for a mild pain of 1-3.
This is set up like this for a reason, so that every pain level can be addressed accordingly. I’ve had many patients try to get nurses to give both Percocet tablets and IV pain meds at the same time and use both on a rotating schedule as often as possible. I’ve clarified this with the hospitalists I work with, and unless the orders specifically state that certain pain meds are for “breakthrough pain,” this is not something you should be doing.
Never assume anythingIf a patient has been receiving pain medications on a regular schedule, but they are still PRN medications, wait for the patient to ask you for them. Don’t automatically bring them into the room. Some people get in the habit of “scheduling” PRN pain medicine, but this is not necessary.
Dilute every dose in a 10cc saline syringeNever give undiluted IV pain medicine, because it will increase the chances of the patient feeling a high. That is not the purpose of the medication, and if they complain about you diluting the meds, explain that they are still receiving the full dose, and that it is simply better for their veins, and just as effective in reducing pain. They just won’t produce a rush or a high.
Push IV meds slowlyLike I mentioned previously, these patients are looking for a euphoric feeling with pain meds. By pushing already diluted IV pain meds slowly, you further reduce the possibility of the patient getting a high from the medication--which again, is not it’s intended purpose.
Expect resistanceDrug-seekers can get creative. They may try to charm you to give them additional pain meds, or call the doctor to get more ordered. Alternatively, they may throw a tantrum and threaten to leave AMA. Do not give in, and understand that you have done nothing wrong.
If you must, verify with the physician that you are at the limit for the amount pain medication the patient can have. If so, calmly explain that meeting their demands are not possible. If they ask to leave AMA, let them leave.
Document everythingDrug-seekers are often liars and manipulators, and will attempt to throw you under the bus if you do not give in to them. Make sure to remain emotionally level, and factually document every situation to avoid any potential blowback.
Spread the loveA drug-seeking patient can ruin your shift. They can be very needy and will have you running a lot, draining you of your energy. Be kind to your co-workers and share the burden that these patients impose on your unit. Give everyone a turn, and try not to assign them to the same staff over and over.
Let us know if you have any additional tips in the comments!