Thursday, September 18, 2014

Tales from the trenches

Dr. Coogie writes in:

This morning I was on the computer, reading overnight notes on my patients. These were the nursing notes on one guy:

00:23  Patient yelled at nurse for pushing Dilaudid "too slow."


01:00  Patient running up & down hall yelling for more Dilaudid.


01:25  Patient called nurse an ugly bitch because she hadn't pushed Dilaudid faster.


02:00  Patient apologized for calling nurse an ugly bitch and asked for more Dilaudid. When informed he could only have it within the schedule set by pain management, he called her an ugly bitch again.


02:10  Patient ran to another nurse's station trying to get more Dilaudid.


02:30 Patient yelled at nurse for giving Dilaudid too slow, said "It's like giving me low octane fuel instead of high octane fuel."


02:40 On call physician notified of patient's behavior.



02:49 Patient seen by on-call physician, who informed the patient he would not be getting more pain medication than the pain specialists recommended.


03:40  Pt escorted back to room by security, who found him downstairs in ER demanding Dilaudid from staff there.




I absolutely LOVE this nurse.  I ran up and gave her a high-five before shift change.

24 comments:

Anonymous said...

IMO, anyone capable of running round insulting people has had more than enough dilaudid.

Shellye said...

Wow...just wow. I hope that nurse has some nicer, more appreciative patients to make up for this one. *smh*

Anonymous said...

Magic Eight Ball predicts "Bad Press-Ganey score."

HeroHog said...

Dilaudid IS the stuff I will admit! Having had kidney stones 17 times now I have become somewhat of an expert on pain and pain meds.
Dilaudid, ask for it by name!

bobbie said...

I love that nurse too!! sounds like something I would have done {the write up, not the wild behaviour}

Anonymous said...

In case anyone is interested, I did check, stun guns are for sale through Amazon, quite reasonable, just saying.

Anonymous said...

Anon @ 8:35:

Yes, indeed.

These will be the PG survey results that will be highlighted in the next staff meeting by management reminding everyone to "always" do everything to manage pain and keep patients comfortable. Nurses will then have "opportunities" to "improve" their scores, or else punishment will be held over their heads.

Dr. Coogie: you're pretty awesome for acknowledging her efforts! That means a lot to those "in the trenches" dealing with patient crap on a moment-to-moment basis.

Anonymous said...

"You don't understand! I'm a guy with ENGINE KNOCK!!!"

RageDino said...

Definitely agree with: "IMO, anyone capable of running round insulting people has had more than enough dilaudid."

Did they examine him for mental illness too?

Sara said...

And jerks like that are why there are chronic pain pts hurting and afraid to ask for meds, just so they don't get labeled a 'drug seeker'. Sorry, personal soapbox.

But I love the nurse's documentation. It helps personify exactly why he'll be accurately labeled a drug seeker.

Anonymous said...

Warrants a FB post. I'm sure this nurse was the picture of politeness & good service throughout her time with this patient.

Christine said...

Physicians don't know what they're missing sometimes when they skip over nursing notes!

Anonymous said...

Well said, Sara (Sept. 18, 3:26 pm). Extremely good point!

Candida Gomez said...

@"These will be the PG survey results" etc.

And this is why I say management and corporate types should work two weeks in the trenches every year, to see what people deal with.

This is why I love the company that runs the hospital I had my kids at. They listen to their doctors and nurses, and understand that some people are drug seekers and shouldn't be enabled.

Laura said...

Oh no. I sense a bad Press-Ganey. Call in the administrators, lecturers, and some mandatory online modules on "patient focused care" for good measure.

Sigh.

Anonymous said...

In my humble pharmacist opinion, I don't think the patient was receiving the correct medication, if he was up and about complaining about push speed and running around the hospital. It certainly did not seem that pain was the issue for this patient. More like anxiety or some altered state of consciousness in pain perception. As for the FB comment, that would get someone fired fer sher. This type of behavior is quite unusual and it wouldn't be too difficult for an astute cleaning person or wandering visitor to figure out who this Dilaudid seeker might be impersonating.

Anonymous said...

Anonyous @1153 is right that the guy was receiving the wrong medication. Order up some succinylcholine and he'll settle right down.

cliffintokyo said...

The nurse's notes are a model of objectivity. Would love to hear what she said about this patient over after work drinks!

bobbie said...

LOL w/ cliff in tokyo...

We nurses would NEVER discuss a patient with anyone else, not even other nurses!!

***gigglesnorts***

Anonymous said...

@humble pharmacist anon re: FB post: I meant it warrants a link to this blog post on FB. As far as I know this is a hilarious figment of Dr. Grumpy's or Dr. Coogie's imagination or at least is anonymized so I think it's safe for me to post a link to this post on FB for the enjoyment of my 200 FB "friends"

Anonymous said...

Maybe he was the one they were going to give the 300mg of valium to?

Moose said...

Sara is dead on. The situation with drug seekers has grown out of control and innocent people are getting thrown under the bus regularly thanks to them.

I'm allergic to a bunch of opiates and resistant to others [dilaudid? might as well give me saline]. Plain old morphine [mofeen!] is one of the few I can count on. Thankfully, I can't stand the stuff and only take it for extreme situations (like, 1-2 pills per *year*).

Typically, I depend on Tramadol, a non-opiate, for pain relief when advil is not enough. However, thanks to abusers and seekers, Tramadol is now on the DEA schedule and is harder to get. Apparently the DEA thinks this is going to reduce the amount of abuse of it. My guess is that this is going to fail and even when abuse rates don't drop they'll refuse to take it off the schedule. They may even move it up the schedule to opiate levels, in which case, it's like a giant "F*** You" to those who really need it. This is America, where when kids using water pistols shoot people with real pistols and get shot, we ban the water pistols.

And in conclusion, I hate humanity. Kill all humans!

rapnzl rn said...

Excellent nursing documentation and compassionate care? Even in the face of WAKING AN ON-CALL UP IN THE MIDDLE OF THE NIGHT????

Heroism!!!!!!

But the consequences will be punitive, absolutely. It shouldn't oughta be that way....

Anonymous said...

Wrong-o. He hadn't had enough.

 
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