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Old 08-25-2014, 05:05 PM
 
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I was reading a BB on use of morphine in treatment of terminal CHF. Numerous posts told of disgruntled family members complaining that they thought the morphine hastened their relative's deaths, even though it made them comfortable and quiet in their final days.

I recall an incident when I was hospitalized for something that required pain control and the doctor had prescribed Demerol for pain when needed. I'd never had Dem. so I knew that it'd knock me out and it did the first time I got it. But subsequent times it did nothing for me. I knew that the nurse was stealing the Dem. and using it herself but I dared not complain.

In hospice during the final days when morphine is required, as for example in cancer, how could a dying patient be assured an addicted nurse would not be stealing their pain-killer and robbing them of a peaceful passing, because I greatly fear this is what's going to happen to me based on my only experience with this situation.
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Old 08-25-2014, 06:53 PM
 
Location: Pennsylvania
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just curious-if you'd never had demoril, how did you know it'd knock you out? It's not unusual for a med to be effective the 1st time or 2, then stop working for that patient.


You actually should have mentioned its lack of effectiveness. Another med could have been given.


If you didn't feel comfortable complaining about the nurse while she/he was your nurse, you could have written a letter after you were discharged. A drug test would have been done and if positive, the nurse would have been fired and most likely not been able to find another nursing job.

As for a hospice situation, the med is usually put in an IV. When the patient wants a dose, they push a button and it's released into the main IV bag. Not explaining that well-there's 2 bags, a main one with saline or whatever, and a littler one with pain med.

Anyway, there's a little monitor that keeps track of when the more recent dose was given. If it's too soon for another, none will be released, preventing the patient from ODing.

No patient has only one nurse. If you don't trust one, talk to another. Or ask to see the head nurse or supervisor.
At some point you're going to have to trust somebody.
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Old 08-26-2014, 09:55 AM
 
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Quote:
Originally Posted by PAhippo View Post
just curious-if you'd never had demoril, how did you know it'd knock you out? It's not unusual for a med to be effective the 1st time or 2, then stop working for that patient..
My wife is a pharmacist. She educated me on the various pain killers and, I mean I'm in my 50's so I've had some exposure to literature on narcotics. Demerol is synthetic morphine. I knew that going in and since I'd never had any I knew it's effects would be powerful. I could control the pain during the day but at night I needed it to sleep. The first night I slept like a baby. Subsequent nights it was always the same nurse who gave me the injections and I never felt the same sedating and pain-killing effects I did the first night. And I know I didn't build a tolerance that quickly.


Quote:
Originally Posted by PAhippo View Post
You actually should have mentioned its lack of effectiveness. Another med could have been given.
I didn't want to make waves, and I figured if she was addicted she'd just steal that one too.


Quote:
Originally Posted by PAhippo View Post
If you didn't feel comfortable complaining about the nurse while she/he was your nurse, you could have written a letter after you were discharged. A drug test would have been done and if positive, the nurse would have been fired and most likely not been able to find another nursing job.
You know, I didn't think to do that at the time. If I had I would have.

Quote:
Originally Posted by PAhippo View Post
As for a hospice situation, the med is usually put in an IV. When the patient wants a dose, they push a button and it's released into the main IV bag. Not explaining that well-there's 2 bags, a main one with saline or whatever, and a littler one with pain med.

Anyway, there's a little monitor that keeps track of when the more recent dose was given. If it's too soon for another, none will be released, preventing the patient from ODing.

No patient has only one nurse. If you don't trust one, talk to another. Or ask to see the head nurse or supervisor.
At some point you're going to have to trust somebody.
Well, the presence of pain would be the main thing. My concern would be if I felt something was not proper and I couldn't do anything about it I'd want to be able to request to be transferred out. To my mind the best solution is for the system to be closed---a bag the nurse can't touch or inject the narcotic into that comes directly from the pharmacy and is sealed so the drug goes directly from the bag to the patient.

Thank you much for the helpful info, by the way.
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Old 08-27-2014, 07:21 PM
 
Location: Missouri
6,044 posts, read 21,131,710 times
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I think assuming the nurse stole your Demerol since it didn't effect you like it did the first time, is a little extreme. It is much more likely you just reacted differently the second time around.

I've worked in healthcare for 13+ years including two different hospice agencies, and I've never come across anything that even seemed like a nurse with an addiction problem. Obviously anyone anywhere could have an addiction problem, so I can't say it would never happen, but I think it's pretty unlikely to occur to you.

1. Hospice nurses (in my experience) tend to be more mature nurses (i.e. not age 22 and just out of school). Statistically, people of a mature age, who are degreed/licensed professionals, are less likely than the average person to have an addiction issue.

2. All healthcare agencies drug test at least upon hire, and certainly if someone is having signs of addiction. So the nurse would be likely to get caught (and risk not only her job, but loss of licensure).

3. Hospice nurses are working with other nurses, not to mention doctors. It would be difficult to hide an addiction issue from other skilled medical professionals.

4. Pain management is closely monitored for hospice patients. If a patient were not getting their medications, other members of the hospice team would notice the patient were in pain.

5. If the patient is at home, the medication is most likely going to be administered by family. If the patient is in a hospital, hospice house, or nursing home, there's going to be multiple nurses administering the medication, so if a nurse hypothetically stole medication, other nurses/staff would notice the patient's pain was not controlled while that nurse was on duty.

6. The biggest risk (IMO) of medication theft from a patient at home is FAMILY, not staff. I have seen that happen lots of times.

7. The biggest risk (IMO) of medication theft in a facility is after the patient is deceased, or if a medication has been discontinued. In that case, the medication may need to be destroyed (sometimes it can be returned to the pharmacy). Every facility I've ever been in, required the destruction of such medication to be witnessed by two nurses, to reduce the risk of theft.

I hope this helps reassure you. And as someone above stated, if you were given pain meds and they were not effective, you should absolutely speak up. That is not unusual at all, it's not "making waves." Your care team wants to help keep your pain under control.
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Old 08-27-2014, 08:18 PM
 
10,179 posts, read 10,541,144 times
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Quote:
Originally Posted by christina0001 View Post
I think assuming the nurse stole your Demerol since it didn't effect you like it did the first time, is a little extreme. It is much more likely you just reacted differently the second time around.

I've worked in healthcare for 13+ years including two different hospice agencies, and I've never come across anything that even seemed like a nurse with an addiction problem. Obviously anyone anywhere could have an addiction problem, so I can't say it would never happen, but I think it's pretty unlikely to occur to you.

1. Hospice nurses (in my experience) tend to be more mature nurses (i.e. not age 22 and just out of school). Statistically, people of a mature age, who are degreed/licensed professionals, are less likely than the average person to have an addiction issue.

2. All healthcare agencies drug test at least upon hire, and certainly if someone is having signs of addiction. So the nurse would be likely to get caught (and risk not only her job, but loss of licensure).

3. Hospice nurses are working with other nurses, not to mention doctors. It would be difficult to hide an addiction issue from other skilled medical professionals.

4. Pain management is closely monitored for hospice patients. If a patient were not getting their medications, other members of the hospice team would notice the patient were in pain.

5. If the patient is at home, the medication is most likely going to be administered by family. If the patient is in a hospital, hospice house, or nursing home, there's going to be multiple nurses administering the medication, so if a nurse hypothetically stole medication, other nurses/staff would notice the patient's pain was not controlled while that nurse was on duty.

6. The biggest risk (IMO) of medication theft from a patient at home is FAMILY, not staff. I have seen that happen lots of times.

7. The biggest risk (IMO) of medication theft in a facility is after the patient is deceased, or if a medication has been discontinued. In that case, the medication may need to be destroyed (sometimes it can be returned to the pharmacy). Every facility I've ever been in, required the destruction of such medication to be witnessed by two nurses, to reduce the risk of theft.

I hope this helps reassure you. And as someone above stated, if you were given pain meds and they were not effective, you should absolutely speak up. That is not unusual at all, it's not "making waves." Your care team wants to help keep your pain under control.
Thank you much for your very informative post. You did give me a few ideas about what to do "when my time comes". No. 1 on my list is to make sure I have a more mature nurse who would be less prone to addiction.

The addiction rate among nurses is about 10%, same as it is for the general population. But I think the figure is higher due to the tremendous amount of stress placed on nurses today to keep up with the demands of the job. My wife sees nurses being fired or disciplined all the time for drug abuse. It's just part of the job, like being a policeman---high stress and constantly having to deal with illness and death.
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Old 08-28-2014, 07:35 PM
 
Location: Missouri
6,044 posts, read 21,131,710 times
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Quote:
Originally Posted by thrillobyte View Post
Thank you much for your very informative post. You did give me a few ideas about what to do "when my time comes". No. 1 on my list is to make sure I have a more mature nurse who would be less prone to addiction.

The addiction rate among nurses is about 10%, same as it is for the general population. But I think the figure is higher due to the tremendous amount of stress placed on nurses today to keep up with the demands of the job. My wife sees nurses being fired or disciplined all the time for drug abuse. It's just part of the job, like being a policeman---high stress and constantly having to deal with illness and death.
I'd be curious to see where you got the 10% addiction rate. Assuming you aren't talking about cigarette smoking (which is certainly an addiction, but a legal one, and not really pertinent to this concern IMO), I have a hard time believing that 10% of nurses have an addiction issue.
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Old 08-29-2014, 05:40 AM
 
48,519 posts, read 81,030,761 times
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yep it a every hard thing to measure accurately. Op afterall did not really have a clue especially not telling her doctor that it wan'ts working ;no matter the reason.
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Old 08-30-2014, 12:03 PM
 
10,179 posts, read 10,541,144 times
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Originally Posted by christina0001 View Post
I'd be curious to see where you got the 10% addiction rate. Assuming you aren't talking about cigarette smoking (which is certainly an addiction, but a legal one, and not really pertinent to this concern IMO), I have a hard time believing that 10% of nurses have an addiction issue.
Drug addiction among nurses: Confronting a quiet epidemic | Modern Medicine

Quote:
The American Nurses Association (ANA) says approximately 10% of nurses are dependent on drugs, making the incidence of drug abuse and addiction among nurses consistent with that of the U.S. population.

Drug addiction is a major health risk among nurses and other healthcare professionals, said Stem. Of the hundreds of cases that come before the State of Ohio Board of Nursing each month, well over half of them deal with addiction, he said.
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