Some say that the R.N. initials stand for, “Refreshments and Narcotics,” and throughout certain shifts, I don’t know if there’s a more apt feeling description of my job.
I don’t know if it’s a regional issue or something larger, but my hospital has been seeing a huge increase in the number of patients admitted for drug overdose and withdrawal. This includes heroin, crack, cocaine, benzos, and good old alcohol. We’ve all seen these types of patients and know how they excel in concocting a perfect night of hell. Let me just say that coming in for a “headache” despite a totally negative work up and being prescribed 1mg of Dilaudid every 4 hours “as needed” is a problem. At home, these patients would surely take a couple of Tylenol pills and call it a night, but in the hospital, all of the sudden everybody’s in the worst pain you can imagine.
Can you rate your pain on a scale of 0-10, with 0 being no pain and 10 being the absolute wor--
Alright, and where is your pain exactly?
Okay we typically only give people having an actual heart attack about 1-2mg of morphine, but here’s the equivalent of about 7mg of morphine just for you.
“Can you get me some more snacks too? And can I get something for sleep?” [flips TV channel]
But we’re never finished after that first dose. Smartphones have alarm clocks and you better believe these patients are setting alarms every so often to ensure they get all the drugs they can squeeze out of this broken system. This could be particularly useful at night but make no mistake, even with all these drugs these patients never seem to sleep. Alarms or not, they keep checking the clock every few seconds to see if it’s time yet. Even the whole, “It’s not time yet,” thing doesn’t stop a lot of them, but at least that’s an easy no… right? Well… sometimes.
I once admitted a patient with a diagnosis of intractable nausea and vomiting which sounds fine, but things spiraled. This patient was a drug addict and loved benzos so all they could do was demand, nag, beg and plead for some Ativan. Despite already receiving Ativan in the ER less than 1 hour ago and after having the patient for no more than 30 minutes I was already asked for Ativan nearly 10 times. Talk about short-term amnesia!
Luckily there was no Ativan anywhere on the chart, so I just kept saying no. It was only 2 am I figured the patient would just go to sleep and give up, but no. They did everything except stage a fall for getting some Ativan and eventually, the physician caved and ordered the smallest dose the pharmacy would allow.
I’ve even seen some patients so brazen as to suggest that the only pain medicine they weren’t severely allergic to was IV Dilaudid, but that it made them itchy so they needed IV Benadryl along with it. The saddest part is that they got a doctor to prescribe it, and this happens all the time. It’s actually rare that the doctors decide to not give in and order these patients every sedating med under the sun during their regular admissions.
After all, it seems like some of these patients live in the hospital. They’re here so often it would be a waste paying rent somewhere else, and in the hospital, they get all the drugs they desire legally and for free.
But how does this keep happening? These frequent flyers are documented poly-substance abusers that congest our halls, waste our precious time and resources, and make a serious case for career re-evaluation. They often threaten to leave AMA if they don’t receive a full list of their “home meds” which always seem to include controlled substances often including Dilaudid, Percocet, Ativan, Klonopin, etc., and have “allergies” to every single mild pain med and usually some psych meds as well.
Good! Let them leave AMA! Bye, Felicia!
Gone are the days when doctors could tell patients to take a hike if they suggested something so outrageous. Not anymore! These days health care providers are basically forced to cater as much as possible to patient demands because sometimes doing what is right can jeopardize HCAHPS.
I still feel like a collaborative approach is needed to all have all healthcare providers working with drug-seeking patients to come together and agree on no prescribing of controlled substances, and then maybe these patients will stop coming back altogether. Maybe then drug seekers will resume getting their drugs and doing them outside of the hospital where it belongs, not in it, and we can focus our time and care on those that really need and deserve it.