Sunday, May 17, 2009
It's Not an ER, It's a Safe Injection Site
I wish, oh how I wish I could take credit for the title of this post. But alas I cannot.
It baffles me, the number of people in this town who have standing orders for IM or IV narcotics. I have never worked in an ER with so many drug addicts who come in on a regular basis for their RN given, doctor ordered fix.
There are a couple of people here who you can set your watch by. Who needs a sundial when you have a Demerol 100mg q4h patient coming through the door?
One of my colleagues remarked today as we were both drawing up narcotics for patients with such standing orders, "its like this place isn't an ER, it's a safe injection site".
The statement made me howl with laughter but then sent me down a more introspective rabbit hole.
Ok. So why should I care if someone is a drug seeker? It doesn't affect me in any way, I am just carrying out the orders. I should be able to give it as impassively as azithromax. Right?
Well except for it does affect me...my tax dollars pay for each visit. I run on the streets that she drives on after her injection.
What if I am the RN that gives the dose that finally puts him in to meperidine toxicity? Am I responsible because I am supplying a drug which has clear guidelines regarding its dependency and possible toxic side effects...supplying that drug waaaaayyy above and beyond the recommendations.
Should I just be pleased that this patient is getting clean pharmaceutical grade narcotics in a safe environment?
Why do I support real safe injection sites and harm reduction initiatives but get irritated every time I see one of the 'standing order' patients in the waiting room?
Is it even ethical for me to enable a prescribed drug dependency?
I've been doing some reading on meperidine use for headache management and it seems to only be recommended if the patient has perfect renal/hepatic function and is getting less than 600mg/24h or for only a 48h window of time. Yeah, no, no, and no in some of these cases. I feel like refusing to administer next time...but that isn't right either. What some of these people really need is a rehab clinic, a support network, a different childhood, coping mechanisms, withdrawal protocols...none of this comes if a self-important RN withholds a dose of medication.