Posted by Lindsay Rae on January 3, 2004, at 21:52:56
In reply to Re: PS. oxycodone is Oxycontin..., posted by Lindsay Rae on January 3, 2004, at 19:04:06
I'll try to make this post as short as possible. However, I am going to tell you all something that has really struck me as horrible about our medical facilities. First, I have worked in a hospital as an RN for seven years. Last night I believe that I had one of the best and worst nights of my nursing career. In order to protect my patient's confidentiality, I will call my patient "Joe." Anyway, Joe came to me from the cardiac intensive care unit(CICU) last night around 11:45pm. He was confused and I got a report from the CICU nurse that he had been in the hospital since 12/23. He had since been restrained, on and off, for the duration of about a week because he had been "confused and beligerant, violent and aggitated". Of course, I'm told, this was for his own good and to protect his IV lines and such. His wrists were quite red and irritated (which is quite minor in comparison to his other issues, nevertheless, he had been soft restrained at the wrists and ankles).
My big issue is this. . . . He had not gotten his methadone dose since 12/23! I couldn't believe my ears when the CICU nurse told me that he was an MMT patient, and that he hadn't gotten his dose since 12/23. What is wrong with our doctors? What is wrong with the CICU nurses that have only 1-2 patients? I held these nurses in high regard until this incident. Anyway, I scoured his chart for any information about his methadone maintenance that I could find. I wanted to make sure that no doctor I knew would deny a patient his methadone. I couldn't believe my eyes when I read that he had come into the hospital with a possible "drug overdose." He was found unresponsive by his wife in a pool of blood coming from his rectum. Obviously this patient had lost a lot of blood and had a GI bleed.I called his wife on the phone to get more details and I became more and more horrified as I spoke to her. She told me that as soon as she told the paramedics that he was an MMT patient, they gave him Narcan. He instantly went into withdrawl. She tried in vane for days to tell them and anyone else that would listen to her that he did not have a drug overdose as he had not left the house for three days, and he could not have Narcan. Upon his arrival at the hospital they did a drug screen to find that he was positive for cocaine. (His wife states that he was in to see his doctor earlier in the week and had his dose increased because he had used earlier that week). Am I being naive? Is that true?
I'm trying not to drag this out, but I want you all to understand the full story. Sorry.
Anyway, he had been in the hospital for eight days when I got him. I spoke with Joe in a very calm voice and told him that I was there to help, not to harm him. I explained to him that I knew he was on methadone and I would do anything that I could to get his his dose by 12:30am. At first, he almost cried to find that I knew he was on methadone, for it was his belief that he would no longer get any pain medication whatsoever. He was only getting small doses of morphine. 1-2mg an hour. (Several nurses since told me that this morphine was a replacement for his methadone and that I was basically overreacting. I told them otherwise.) I don't know when the last dose was given to him. It had been so long. Anyway, I instantly got on the phone to the intern that was covering for his doctor and demanded that this issue of no methadone be addressed NOW! His confusion was possibly and probably because he had not received any dose for seven days. And, it was written in his chart that they were delaying treatment due to his confusion. (What a viscious cycle). She ordered him his dose to be given every day. I was happy with that. But, the pharmacist called to tell me that he would not dispense it because federal regulations don't allow him to dispense methadone from the hospital for maintenance. I then demanded he dispense at least the next two days worth because I know from reading on this site that it is possible despite the federal regulations, just long enough to get the dose started from his mmt program. The ironic twist here is that his mmt program has been contacted on day one of his admission. They attempted to get in touch with Joe's doctor but of course, Joe's doctor is too busy except to write in his chart that he has a substance abuse problem, that he is recovering, and leave it at that. Nothing further has been done. The other ironic twist is that this doctor is my husband's doctor also. My husband is the reason I visit this site. He's an MMT patient. I need to find another doctor for my husband ASAP. He's been in the hospital for pancreatitis prior to his methadone program and he now is reactive to Hep C. I don't want this to happen to him. Of course, I will be the assertive one yelling and stomping my feet until he gets his dose. But, I just couldn't believe all this mess.
In the end, I wrote a long and quite rude note to the doctor, taped it to the front of the chart so it won't be missed, and told them that if this patient isn't given his methadone here in the hospital, you can count on a lawsuit from the family because he will possibly walk out, kill himself, or go use as soon as he's discharged. And, I also wrote down the number to Joe's methadone facility so that they can get in contact and get this man his dose.
Joe rested quietly without restraints for the duration of the night after he got his dose of methadone at 12:30am. He had no confusion and he thanked me every time I went in to see him. That's what nursing is all about. I feel like I helped him. But my question is. . . is this happening everywhere?
Sorry this is so long. I wanted you all to understand that there are nurses out there who do care. There are also idiots who think that morphine will suffice instead of methadone. I have since educated them that a patient needs both methadone AND additional pain medication for any pain. Thank you all for listening to my gripe.
Kim Ann
poster:Lindsay Rae
thread:287428
URL: http://www.dr-bob.org/babble/subs/20031208/msgs/296162.html