The Sixth Right?
A commenter ("poky") on another post suggested that letting a patient know what medication they were being given was one of the "5 rights." I believe this referred to the five rights of medication administration, which are: right patient, right drug, right dose, right route, right time.
I see nothing in there about letting the patient know what medication they are getting. Am I missing something? Is there a separate statute in the code of nursing ethics that states that an agitated patient has the right to know if they are getting Haldol instead of Ativan?
Are nurses also really required to inform their patients that they are only getting 2 mg of Dilaudid instead of the 4 mg they requested? Drug-seekers ALWAYS want to know how exactly much narcotic they are getting. Do they really have the right to know?
I see nothing in there about letting the patient know what medication they are getting. Am I missing something? Is there a separate statute in the code of nursing ethics that states that an agitated patient has the right to know if they are getting Haldol instead of Ativan?
Are nurses also really required to inform their patients that they are only getting 2 mg of Dilaudid instead of the 4 mg they requested? Drug-seekers ALWAYS want to know how exactly much narcotic they are getting. Do they really have the right to know?
Labels: drug-seekers, nurses, pain, questioning authority
posted by scalpel at 6:47 PM
34 Comments:
When I removed the subcutaneous tumor from my dog I didn't ask Molly if she was comfortable. I just did the dirty deed.
When the good Dr. sprayed my keratoses with nitrogen I didn't coach his application time.
Responsibility falls where it falls; We are equitable only under equal circumstances, if you are fallen and I am standing then you have no choice in how I see you to your feet.
Well, if I'm your patient, I'll expect to be told the name of the medication and the dosage at a bare minimum. Otherwise, I might need to refuse until more information can be made available, in order for me to give "informed consent."
Why is it just with narcotics though? Nobody ever asks whether they are getting one or two grams of Rocephin, or what rate the Cardizem drip is infusing.
Any awake, oriented person has a right to know what & how much drug they are receiving. People are more attuned to narcotic doses because that is something they receive more regularly. Many times people will tell me they are "allergic" to narcotics when what really happened was they got overdosed and had severe side effects. So, yes, it is very useful for patients and RNs/MDs to know that 1 mg. dilaudid either does nothing, relieves the pain or puts them under for four hours. If they are drug seekers and you've already decided to give them narcotics, then you might as well give them the dose they want up front.
If they ask, I'll tell the truth. I've had many patients tell me they want more narcotics than the doctor has ordered for them. "So am I to understand that are you refusing the medicine I am prepared to give you?" is my follow-up question, and I move towards the door. If they don't want what I've got, I don't care. I'm not interested in a debate and I'll let them know that. When it comes to the out of control psych patient whose rights have already been abridged by their being held in an ED against their will, I'll still tell them what I'm giving them, and I'll tell them that they don't have the right to refuse. I give them the choice of doing it the easy way, or the hard way. But I'm not going to lie.
As part of informed consent, a competent patient has the right to know what medication he is getting. For incompetent patients (like the patient in the previous post), the surrogate decision maker can decide whether or not the patient should be told, based on the best interests of the patient (the best interest standard does not apply in all states). In emergency situations in which no other surrogate is immediately available, the doctor can act as the surrogate and decide whether or not to tell the patient.
i have no problem with telling patients what medicine they are getting and why, IF they want to know. on the other hand, they contract with me to diagnose and treat them and it pisses me off to have every order questioned...
"they just did that last week,"
is my favorite.
whatever. i think we should still be able to give placebos personally, much cheaper and more efficacious than the 40th workup in one year for that evanescent and atypical abdominal pain that moves around the belly without reason.
on the scale of doctor's as magical, wondrous figures to them being highly paid charlatans i would prefer the former to the latter. i guess it used to be that way.
in the er i think i do a pretty good job of translating into non-medical speak and giving off a caring demeanor, but it's very hard with many of my patients when they 'just read about it on the internet' and think i'm a moron. they may be right, but i'm a highly educated one who knows more about medicine than they do.
A big "ditto" to what Lou said above.
I typically just make a bland statement, like "I'm going to order something for your nausea", after re-confirming their allergies. Oftentimes medication choices change based on whether or not their IV just "blew" or what surgeon is on call. I don't hide anything, but I'm not going to offer up a whole ton of information and explanations either. Most patients just seem to care that their pain/infection/nausea is being addressed.
They come to ER to be diagnosed and treated, it's not "your way, right away" like at Burger King.
If I may be so bold as to project my thoughts on to your opinion piece...I hear what you are saying about nurses and patients questioning your orders. Maybe not questioning; but the staffs desire to inform the patient in regard to what meds the patient is receiving.
I think what you are saying goes tremendously deeper then the surface argument. I think you are having a visceral rxn to YOUR treatment plan.
It goes something like this: You are presented with a patient that obviously has abdicated their own personal responsibility to "THEM". Is probably on medicaid, welfare, badgercare or whatever your state calls it. Has public assistance for every aspect of their lives.
Yet, the patient is from all outward appearences a functioning human being that could 1) be working and not sucking off the hind tit of society, 2) could have seen their own PCP IF they had any ambition to make/keep an appointment, and 3)has a "tude".
So when you are presented with this type of patient: somebody that from all appearences, DOESN'T want to make any decisions for themselves, and then they are questioning your med order.....shazam!!!! I can see why you have a kitty fit.
And then to have the staff also fall into that attitude...zoweee!
The patients that we deal with today are not like the previous generations. My mothers generation would just "go along with what ever the doctor said". Just because the doctor usually was the most educated person in that town. The doctor represented the highest form of intelligence, and you didn't question his decisions.
Nowadays, everybody has an opinion. Even if they clearly have abdicated their personal responsibilities.
So, now that I have identified a commen societal problem...what can we do about it?
In the near term: continue to care for the great unwashed masses.
In the far term: vote for representatives that WON'T allow an expansion of the welfare state.
Steve
I have to agree that a competent patient does have a right to know exactly what they are getting. I always tell them what I am giving them before I place the order -- especially if I anticipate it being contentious. I use the same policy I use with my three-year-old. I'm informing you what you're getting, not initiating a negotiation. You can say no (unlike my three-year-old), and absent a medical emergency, I'll be happy to let you go home. But you gotta tell 'em, and I hate to leave that to the nurses.
For dc Rx's I'm very opaque when it suits me. When someone has, say a minor back strain, has a history of frequent ER visits for same, no contraindications, I love prescribing Indocin in response to their request for "pain medicine for home." Most of them have never heard of it, it sounds a little like Vicodin or Endocet, so they tend not to refuse. If asked, I describe it as a "pain medicine" and tell them that I my experience is that it works well for pain like they have. No dishonesty, but I don't go out of my way to describe it as "non-narcotic." And it should work -- it's a great NSAID.
don't stab my daughter with morphine. She's allergic to it
As a patient, I would like to know. I think patients should be informed either at the time of administration or at time of discharge because if they do have a bad reaction they need to know which meds to avoid in the future. Or if they need to follow up with their doctor, they need to know what they were given (yeah, I know the docs can call the ER, but I've never seen that happen.)
Although,I can see how this may not apply to the average drug seeker or mentally ill person.
M
Yes, a patient has a right to know, even if they are drug seeking. Which is why I end up calling the md back at the patients request. I will say this, if they request pain med and I'm giving it, I will say this is this drug, if they don't ask the milligrams I don't always tell them. I would not however give a completely different drug without them knowing.
For instance a drug seeking person is going to be discharged soon and the doctors want to wean him off iv pain meds. they start by lowering the dose, or changing the drug from dilaudid to morphine. we could not tell the patient, but then when we step him down to po meds or no meds at discharge he is going to cause a large scene. It's pay now or pay later, but there is no easy answer and tricking patients will come back to bite you, or me-since i'm the one in the room getting screamed at all night.
Yes. without question you tell them. In fact I always tell them. It's my last step in my drug check. I have the order in one hand and the drug in the other and I tell them what the order says, hell with the more fractious I let them read the order themselves and then I tell them how I am going to give it. When you are wildly busy it's just a final safe guard. Until you make a med error I guess it wont be an issue for you. I made one twelve years ago in nursing school. It was harmless to the patient but it gave me a huge scar.
It was a simple communication error during a busy med pass that could have killed a patient.
I do things for me and my well being at work and the side effects are informed consent. I also don't change my practice for narcotics. I have no personal involvement in your needs or wants. If you want drugs it doesn't affect me. It's the patient with the problem not me so I just cannot get into all this judging the drug seekers. Who cares? Give the dugs, don't give the drugs..whatever. The opinions of my patients are worthless to me. They are not family, friend, co-worker why I would care what their opinion of my care is?
My motto is be polite, be informative and be productive.
I am not saint nurse here to judge and nag.
Steve, I am LMAO at you! Talk about having a "tude"....Baby, you got one.
I was under the impression that drugging someone without their consent was illegal and constituted assault.
While this statute clearly does not apply the case in a case of emergently need medical treatment (in the same circumstances that general consent for treatment is waived), I do think that a lucid individual has the right to know exactly how much medication they are given (and to not have medication administered without consent).
Everybody signs a consent to be treated before I even see them, I'm pretty sure. and if they can't sign, then emergent consent is implied.
Nurse comes in, with penicillin (I'm allergic). I have questioned what I get, nurse gets angry, I "if I was really allergic the doctor wouldn't prescribe it - there's a red tape on charts for allergic people".
The doctor came in, angry, knocks me over with his booze breath (at 3:00pm) saying "This is a hospital it isn't a big mistake you'd be fine here" and said that I needed something for anxiety, as I should have just "seen what happened" as they were busy.
Chart had a big, red tape on it "penicillin allergy"
You have no right to treat someone without consent. They can't consent unless they know what you are going to give them.
You are a doctor, not a parent and not a god.
I don't think the "5 rights" means rights as in "right to know", I think it means correct.. my school teaches the 6th right as documentation. As nurses we are advocates for the patient and can obtain informed consent. Shouldn't the (sane, lucid) patient be informed as to what they are receiving? I had a post surgical (abdominal) patient recently, nice little lady in a lot of real pain and it helped the doctor adjust her dilaudid that she knew what doses she had been getting at what times.
I'm back :)
One of my clinical teachers always told us that you can't be sure it's the 'right drug' right if the patient doesn't know what it is, so that's where I was coming from on that. Nurses are expected to act as advocates, and I would myself also feel wary before just shooting a patient up with something without telling them what it was. However I think in the situation given I'd give it. Sometimes a nurse just has to step back a moment and think, because when the lawyer comes around they're going to want to know why YOU didn't question it and why YOU gave it, not the doctor.
When I take my car to the mechanic, he calls me before ordering parts, and gets approval. I don't see any reason that medical treatment should be handled differently. Sure; I'll probably have to go look up what part the mechanic's ordering (if I knew what it was, I'd probably have already fixed it myself) but it gives me the opportunity to make an informed decision, since I'll be paying the bill later anyway.
Now, for the medicare patients, you should put that decision to the taxpayers for a vote.
Since I have bad reactions to really routine drungs-like benedryl, generic synthroid, and cortisol-I have to know what my dr is giving me. I doublecheck every script and every bottle bfore I take anything.
Only in the case of noncoherence or psychosis could you justify not being honest.
Does a non-medically trained patient (a layperson) even know enough about drugs to make a decision about what they should be getting? I don't think so. That is everything from antibiotics to narcotics.
Is a person who is hallucinating and so on "in a right mind" to make an informed consent? I don't think so.
What medications and dosing should be up to the medical doctors and anyone else who is allowed by law to prescribe prescription drugs.
This reminds me of what I read in The Wall Street Journal about mental health patients writing up treatment preference plans while they are competent and will then use them when they are in less competent states of mind. An example was given of a person who reacted badly to certain drugs (was it Haldol?) yet while having a mental illness episode she would not be able to convey this information to her health care providers (some other drug did work well and fine that she knew of).
You have a very difficult job and I'm not ashamed to admit I could never handle it and that is why I'm not a nurse or an ER nurse. I used to work as a medical assistant, went to school for that, and later worked for an HMO in the medical department (with a lot of nurses who had burned out of hospital nursing work). I'm also interested in medicine and wellness and I read quite a bit about it compared to typical laypeople.
Thank you for doing the hard work that you do!!
I wish people were more involved with medicine and their own health. They should be told if they display interest since technically the patient has accepted any and all tx you might have for them....they can technically decide at each point in tx if they want to continue.
A right? Unspoken, I guess. I can't tell you how many times I tell a patient what they are getting and they remember an allergy (or their family member does) - not just narcotics.
I will tell a patient what they are getting; I tell them how much only if they ask me directly.
Frankly, the only ones who ask the dosage are the ones who always get the same thing no matter when they come in. And they will ask until they reach the requested amount.
The average patient only wants to know what and not how much.
I don't see what the big deal is about telling patients what they're getting.
The patient is the one who is going to undergo the effects; they certainly have a right to know what you're prescribing, and what the side effects are.
Is there a reason why some drs. forget that they are dealing with human beings? If you only want to practice on inanimate objects, move to research, or practice on yourself!
I think a patient has a right to know about everything you intend to put into their body. I always ask no matter what type of medicine it is or what I am being treated for.
If the dopers don't like your answer, show them the dooor. If the crazies don't like your answer, show them the rubber room.
Any decent person will not give a doctor that is trying to help them a hard time or try to second guess them.
I think it is a basic human right to know what another person is trying to put in your body.
Just my opinion. You can bet that if I ask what you are giving me and you don't tell me then we will have a problem and I will not allow the treatment and I will go elsewhere.
You definitely need to tell me what you're giving me. There are certain things that just don't work with my system, and you may not know that unless you tell me what I'm getting. IV Reglan gives me extreme anxiety but Droperidol is a wonder drug. IM Toradol is a painful nightmare, and I refuse to ever have it again. Amerge is the only triptan that causes a severe drug reaction, so I stay away. I can't be given steroids because of an underlying medical condition. I'm not a stupid patient. I actually know quite a bit about what does and doesn't work for me. And I'd prefer a doctor who's willing to work with me as a treatment partner rather than as an authoritative dicatator.
It never occurred to me to ask about dosage, but yes. As a patient, I have every right to know EVERYTHING that's going into my body, and I do ask. I don't know if this is possible, but let me give an example from your post (I don't know how chemically similar they are, nor what they're for, so this might be ridiculous. But it is example only.)
I'm asked if I have any med allergies. I say no. I'm given Haldol in the ER and so informed. Later, the order is switched, but I'm not informed. I have a horrible reaction to the Ativan. I'm under the assumption that it's the same drug. I'm hospitalized a year later. I tell them I'm allergic to Haldol based on my previous experience. They give me Ativan instead, and hooray! Horrible reaction!
Yes. I have the right to know what is going into my mouth, my veins, my ass, whatever method you're introducing it to my system.
There is a little thing called informed consent. It is an ethical violation to not inform your patient what drug and dose you are administering to them. Many doctors have been sued for medical malpractice for not doing so. What you may see as a drug seeker may actually be someone allergic to another narcotic.
Besides a violation of the law, it is immoral to give a patient a drug without first explaining what it is, what the dose is, and what the possible side effects are. Only with such information can a patient truly make an informed decision as to whether or not they choose to take this drug.
A doctor does not have to administer a narcotic if they do not believe one is needed. No one is forcing you to administer these drugs, all you HAVE to do is inform the patient of the type of drug, the dosage, and possible side effects. Not so difficult is it.
Oh heck, I personally couldn't give a whit.
If you actually tell me what's going in the IV, etc. I'm going to be able to remember the drug name for about 30 seconds total.
I'm perfectly happy being told I'm being given "something" for symptom X, it's going in orifice Y, and might have side effect Z. Everything else I can read about on the insurance bill later.
911doc writes, i think we should still be able to give placebos personally
As a patient, I agree. I think I might be prone to psychosomatic illness. For example, I can get a case of the runs just by watching someone else eat a lot of sugar. I would love it if a placebo worked.
But placebos may not be cheaper. I read a study recently that determined that the more expensive a placebo is to the patient, the more effective it is. Hee.
in the er i think i do a pretty good job of translating into non-medical speak and giving off a caring demeanor, but it's very hard with many of my patients when they 'just read about it on the internet' and think i'm a moron.
A lot of patients may not have thought about the tens of thousands of hours you are ahead of them in "education." Also, TV gives people a pretty poor impression of what the practice of medicine is really like. Well, except for "House." ;)
i'm a highly educated one who knows more about medicine than they do.
I agree, and on a medical matter, I would never presume to substitute my judgment for yours.
On the other hand, I know more about me than the doctor does. Doesn't what the patient knows, other than their medical 'knowledge,' ever affect your judgment in a direction that the patient is trying to move you?
Post a Comment
<< Home