Dr. Candyman has been working a lot more lately, which means the worldwide supply of 2 mg. Dilaudid syringes is dwindling. Inform your oncology and pharmacy department leadership now.
His response to any questions of why he's prescribing high-powered narcotics to everyone from those with documented narcotic/sedative overdoses requiring intubation to those with seven or eight pain visits this month alone is always 'who am I to judge whether or not someone is truly in pain?'
Oh, I dunno, because you're a doctor and it's part of your job to judge peoples' pain, and it's actually illegal to prescribe narcotics to those that you suspect of misuse or diversion? Don't mind the dumb little nurse and her silly girl questions. F**ker.
Anyway, so Candyman was on, and one of our drug-seeking regulars came in with some random pain complaint. He waited in the room for awhile while Candyman dealt with a couple of emergencies that required something more than Dilaudid.
He dinged his call light.
Drug seeker: How long is the wait? I've been waiting for AN HOUR.
Me: Well, I dunno, when Dr. Candyman is finished with these life-threatening emergencies, he'll be able to come look at your shoulder. You know how this works.
Drug seeker: Well, this is BS because I need my Percocet refilled before all the people at my house leave. There's a party going on there right now, you know?!
Me (deadpan): I'm confused. Are you saying that you need Percocet for your party or for your shoulder? We don't provide Percocet for recreational use here.
Drug seeker: No for my SHOULDER. I just have all these guys back at my house, and I don't want to miss the party!
Me: Well, I'm not pulling him out of an emergency because you're having a party at your house. You'll just have to wait, or if you don't want to wait, I'll give you a form to sign so you can get back to your party.
And I f**k you not, Dr. Candyman actually gave the guy 2 mg of IM dilaudid and #20 Percocet for the road.
Dr. Candyman: Your party hook-up.
Maybe Dr. Candyman had an invite.
ReplyDeleteReally? Doesn't anyone besides you look at the prescribing trends in your hospital?
ReplyDeleteYou can't force an addict to quit abusing drugs, the addict has to know they have a problem and want to stop.
ReplyDeleteYeah, but you don't have to willingly hand over drugs to them either, especially if they don't have a gun aimed at you!
ReplyDeleteHow does he escape DEA scrutiny?
ReplyDeleteThe DEA has bigger fish to fry, like those pill mills, etc.
ReplyDeleteKind of a sidetrack, but it amazes me how easily a doc will prescribe 2mg of Dilaudid to any random person off the street. But you'd never see 15mg of morphine -- which is the equivalent to that dose.
ReplyDeleteI would so write an incident report about this.
ReplyDelete0/10 medical directors would give a shit if I wrote something like this up. Seriously. They are usually hands-offy surrounding things like this. Unless I'm like 'the guy is doing drug deals in the parking lot', they usually stay out of it.
ReplyDeleteYou know what, there IS a shortage of 2mg Dilaudid syringes. My hospital is stocking ampules right now instead. I'm so glad you explained the reason!
ReplyDeletePS: Who thinks it's a good idea to store injectible medication in a glass container that has to be broken anyway????
agreed! I hate breaking those! I've spilled expensive stuff, gotten shards of glass in the ampule, and get annoyed with having to use a filter.
ReplyDeleteWe've had to switch to ampules for both dilaudid and fent. And the hospital ran out of pre-filled 10 cc saline syringes for a day or two.
ReplyDeleteIt's that Mayan Apocalypse thing, I'm telling ya.
FYI to the people who have issues with ampules: Take the plunger out of a 3 cc syringe so it's just a hollow thing and use the space in that to break off the top of the ampule. The top will go into the syringe and you won't cut the sh*t out of yourself. It's a "make your own safety device".
ReplyDeleteWho thought it was a good idea to put a drug in a container that you have to smash to get access to?
ReplyDeleteI guess it is a bit like a piggy bank....smash->reward.
Nurse K, that is brilliant - way better than my wrap-in-packaged-alcohol-wipe technique.
ReplyDeleteMarissa--Someone showed me that after I'd been a nurse for about 2 yrs. Never have done it any other way since. Works well every time!!!
ReplyDeleteThe syringe idea..brilliant. I wish someone would have told me sooner. I've been a nurse about 2 years and am transferring to the ER soon. I float down there on occasion to provide comic relief to the staff with my inexperience. They liked it so much they have asked me to stay full time on the weekends. At night.
ReplyDeleteDr. Candyman's behavior will insure that you get more of the drug-seekers. They'll even call the ED to see if he's on duty.
ReplyDeleteI float down there on occasion to provide comic relief to the staff with my inexperience. They liked it so much they have asked me to stay full time on the weekends.
ReplyDeleteGet a blog.
Dr. Parker: We're already at about 40% factitious disorder/malingering/seeking on night shift as it is.
So this is totally off on a tangent, sort of, but HOW do they come up with medication shortages, why can't they just make more? It isn't like they are using fossil fuels or something that cannot be replaced.
ReplyDeleteRight now I'm on Enbrel (thank you Jesus for that drug!) and methotrexate. The MTX is essential to keeping my symptoms totally at bay, even the Enbrel, miracle that it is, doesn't cut it alone. And I'm informed that it is on backorder, no one has it. Really? I just don't understand it, this is a cheap, old and common drug, used for lots of things, not some obscure thing no one ever orders anymore. So no MTX, I guess I'll be hosed too when that snowballs on me and I go in to find out the 2mg Dilaudid syringes are on backorder too! Thanks a lot Dr. Candyman!
@Amy - A small part of is the shortage problem is that FDA seems a little trigger happy lately (in my opinion) about closing drug manufacturing facilities. Another part is that, if a drug isn't terribly profitable, manufacturers will shut down production on that drug for awhile and use their resources to make drugs that ARE profitable. On a related note, several companies have simply stopped making injectable drugs, because there isn't enough money it it for them.
ReplyDelete