Drug Seeker? Or true pain

1. Drug Seeker? Or true pain Feeding an addiction or healing pain Jen Copeland

2. discussion What are the signs of a drug seeking patient? • Appearance? • Behavior?

3. Situation • A patient was admitted to the unit complaining of a headache. Her vital signs indicated she was hypertensive. She was prescribed IV Morphine q 4 hours prn for pain. The patient repeatedly requested the attention of the nursing staff in an angry manner. She verbalized unsatisfactory feelings toward the facility and the nursing staff. The patient continuously complained about her pain level and requested pain medication before the time of her next scheduled dose. She voiced feelings of not being treated fairly, due to being denied pain management. This patient was scheduled for a stress test at 07:30 which required removal of her nicotine patch and the status of NPO after midnight. She was not taken to her stress test until 08:30 and was extremely angry at the staff for not complying with her scheduled time.

4. Situation • Immediately when her stress test was over, a request from that department was made to deliver her morphine and nicotine patch. When the patient returned to the unit, she was angry and began “clock watching.” Her fury increased when she was educated on the medication order for morphine to only be administered q 4 hours. The patient repeatedly stood in the hall, voicing concern and displaying distress as nurses walked by. The patient commented that “Mercy Medical Center was on their game, and would never treat a patient like this.” The patient requested a script for Dilaudid upon leaving the hospital because she felt morphine did nothing for her pain.

5. Discussion • Is this patient a drugseeker? • How would you care for a patient whom you felt was deliberately admitting themselves to the hospital to obtain narcotics?

6. action • The nursing staff designated this patient as a “drug seeker” and a “hard to deal with patient. Jokes were made on the patients’ behalf between the staff and the doctors. Remarks were made inferring that “the patient should be happy she was being provided any care because most likely she owed Affinity money.” When medication passes were being performed, her room was usually not immediately attended to and comments were made inferring to “let her suffer a little.”

7. action • Her medications were still administered in a timely manner. When my preceptor and I were in the presence of the patient, we conveyed that her medications would be delivered on time, and reeducated her on the dosing schedule. We listened to her concerns and offered empathy. I offered other pain management techniques such as rest, and provided her with snacks and drinks of her choice until her lunch arrived.

8. outcome • The patient remained extremely infuriated with the nursing staff. When she was provided with medication, she conveyed new complaints due to her roommates’ monitors beeping non-stop and preventing her from rest. She was calmed when I provided her with her medications, but still voiced her concerns about the facility and staff. On discharge, she divulged that she was considering going to the “higher ups” about the staff and feels she could have a law suit.

9. REFLECTION • Pain is subjective. • Clocking watching is a common behavior of an anxious patient • Denying narcotics to an addict, does not help them to overcome their addiction. • Autonomy, Beneficence, Justice, Non-maleficence • Referral to pain specialist

10. references • Finney, L. (2010). Nursing Care for the Patient with Co-Existing Pain and Substance Misuse: Meeting the Patient's Needs. MEDSURG Nursing, 25-30. • Cipriano, M. S., & Ludwick, R. (2012). Ethics: interstate nursing practice and regulation: Ethical issues for the 21st century. The Online Journal of Issues in Nursing A Scholarly Journal of the American Nurses Association, 1-4.