Saturday, October 08, 2011

just kill me now

Is there a limit to the number of narcotic pills that a doctor can give a patient in one prescription? Apparently not.

A lot of states have a system in place that tracks prescriptions and is accessible by doctors and pharmacists. Enter patient who had never been to our ER before... Presents with story of chronic neck pain from an accident a year ago. Blah blah woof woof. SSDD. Okay?

Look this guy up and he had received a script for prescription narcs for a month ago in the amount of 350 tablets. I kid you not - 350 tablets. Oh but that's not all. In the following 3 weeks they recieved one script a week I assume from another doctor for more narcotics in the normal amount someone would get. So lets say he recieved only 20 tablets in each of the next 3 weeks because I can't remember the exact amount. So that is 410 narcotic tablets in a months time. So I wonder what this guy is doing with all these narcs? I'll give you three guesses and the first two don't count. Lets say the street value of the pill he got is $5, that a cool $2,050 in the pocket with no trouble at all. Then we wonder where the prescription drug problem comes from in this country.

Oh did I mention that despite all of this info, the patient got an injection of narcotics? Oh did I mention that they left as soon as they got the injection?

A lot of docs seem to have this philosphy that you give 'em narcs in ER and then don't give them a prescription and everything is copacetic.

Docs would say I have to relieve their pain, thats why they came in. I don't want a complaint. I don't want them to make a scene. There is toradol, ibuprofen. Why not go there? I just do not get it and I never will. I really want to understand a docs reasoning with all of this because this is the kind of stuff that makes you want to leave nursing. It feels really sleezy to be part of this. Every time you are part of this kind of stuff it takes away a piece of your soul.


Anonymous said...

It's not your fault it's the doctor's orders.

The worst thing is when someone who is geniunly suffering it makes it harder for them to get relief due to those low lifes.

Anonymous said...

It's not your fault it's the doctor's orders.

The worst thing is when someone who is geniunly suffering it makes it harder for them to get relief due to those low lifes.

Miss B. Havior said...

As long as the sleazy and frequent fliers fill out The Press Ganey, drugs will be given!

The HipCrip said...

I realize you front line ED RNs have to face a barrage of drug seekers every day, but please don't be so quick to judge your patients. There are legitimate reasons why a large number of pills are prescribed.

I can only imagine what you'd think of me when I rolled into you ER. I just filled a prescription for 275 5mg methadone tablets [that's 15 mg taken three times a day for thirty days], and have a second script for 150 30mg tablets of oxycodone. EVERYONE jumps to the conclusion that I'm an addict and drug seeker. I have even been accused by an ER physician of deliberately breaking my tib/fib so I could get the 'D' drug. [She refused me any pain meds and called me an addict from across the ED.]

The reality of the situation is that I have been living with 24/7 central pain from surgeries and radiation for a malignant spinal cord tumor for over 30 years, and am under the care of, and have a contract with, a pain management specialist.

I resisted going on methadone, which is the most effective opioid for managing central pain, for years because of the enormous stigma associated with this drug. Anyone wondering why when all I see in nursing blogs are posts like these?

The HipCrip said...

BTW, for those of us in severe pain and are opioid tolerant, do you honestly think we'd be in the ER if ibuprofen did the trick? We sit at home and suffer when our pain gets out of control because often that's preferable to going to the ER and dealing with being labeled a junkie and offered no more help than Tylenol, number three [a la WhiteCoat].

Toradaol/tramadol are a good option and starting point for those with questionable diagnoses, but for someone with a documented history of chronic pain, they're as useless as the ibuprofen.

linda said...

Sing it sister!!!
Also an ER nurse, I get where you're coming from. Soooo many patients who have obscure symptoms that are subjective - no known [legitmate] injury, VSS, that they do the 'ER hop' and no matter what we do their pain is still an 8. I mean really. If your pain is that severe, wouldn't you want your care to be as seamless as possible -one doc driving the bus to comfort?
I suppose that it IS possible for someone need the sheer volume of narcotics we dispense to them but statistically there are that many people with intractable pain? com'on!

Tinyfeet28 said...

I'm an er nurse too now and I agree but "those" dang patients go nuts when you offer them toradol or ibuprofen! I try to sell IV toradol like it's something amazing b/c it's IV but they know... and if they don't know they find out when they don't get that little buzz after they take it. I've had people tear up motrin prescriptions in my face. If EVERY er or primary doctor stopped writing percocet/vicodin Rxs maybe things would change. For now, I just want to get the patient out of my ER. (I know this is totally insensitive and counterproductive...)

Anonymous said...

As as fairly new nurse I still wonder, as I did in school, why all of the griping by nurses about drug seekers. Why do you care? If doc prescribes it, just give it - its your job and mine. You aren't paying for it and it's not harming your body. If you want to change things, become a doctors and then you can have a chance NOT to prescribe it. Or lobby for changes in the law. Otherwise, don't assume you know someone's pain level - it's not your job!!

Anonymous said...

On another level I must add this. I went to the ER with my son. Furnance wasn't working correctly and I was concerned about carbon monoxide poisoning. Turns out me and my son were perfectly fine. BUT the ER doc gave me a prescription for Vicodin.... Hmm I never said I had pain. I ripped the prescription up. Seriously?