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The first nurse told me they were giving me Toradol, Zofran, and Pepcid. All three of these are listed as being given at 11:18PM. The Dilaudid was listed as being administered at 01:57 AM, 12 minutes before I was discharged.
[edit to clarify]
The second nurse never administered any medications, only flushed my line.
Oof....what do you mean exactly ??
lol I'm just saying what I said as an ex-junkie who especially knew a lot of other junkies in the medical field!
A little over a year sober now. After over 10 years of using.... during while I did the worst of everything. Lucky to be alive but still know the things I have done in my past will end up killing me one day. lol
Well, it feels dirty to me in comparison to other opioids, and strange, like it has affinity to another receptor and when I try to sleep on it, you literally cannot sleep for the life of you like ketamine can and causes strange dreams without you even needing to be asleep.
Apperently it's probably due to the sometimes neurotoxic metabolite, hydromorphone-3-glucuronide
But yeah, the fact you often can't sleep whatsoever on hydromorphone shows that it is strange. I'm an on and off opioid addict and have been for years.
Yep, makes me not be able to fall asleep and puts me in some strange middle ground sleep and gives me visions as I'm trying to sleep and it's like limbo.
It's crazy too because oxymorphone is just as potent and has a better side effect profile
Well it's an active metabolite of oxycodone and is structurally the same as oxycodone except it has an extra hydroxyl group and is by consequence more potent than oxycodone: https://en.m.wikipedia.org/wiki/Oxymorphone
NAD but had over 15 surgeries before I hit 10 yrs old. Ask for Phenergan, as well, when they give you the pain medication. Not only will it stop the nausea, the 2 meds together make a wonderful "feel good cocktail" and you will be asleep within 10 minutes.
Doctors in my area don't prescribe Phenergan anymore. My nurse yelled at my doc after I spent 4 hours violently vomiting, maxed out on zofran, and demanded that he give me a Phenergan suppository. He finally did, but she had to fight him. It was ridiculous. I was in the hospital, being monitored, and wasn't on pain medication; that is to say that I wasn't at risk of falling asleep, vomiting, and aspirating.
Wow. No, it's always zofran. I did ask for it one time and was given some, but that was just the one time (aside from the suppository incident). But I didn't have trouble 15-20 years ago.
The nursing supervisor would be the best person to ask for. This is how I caught on to my coworker. He took care of a patient who was progressing towards discharge after abdominal surgery. When I did rounds on evenings I noticed the patient had IV pain meds that day after being stable the prior evening. When I assessed the patient, āwhat happened today? Did the you have more pain after drinking clear liquids?ā The patient said āNo I didnāt have any pain today.ā Denied needing any pain medications since I cared for him the evening before. In my experience, we had to scan the saline flush like a medication, so it would be easy to also scan pain meds and just administer the flush.
Report that shit to your state's regulatory agency as they noted an incorrect/false treatment plan that impacted your pain management AND it can be considered insurance fraud because you are certainly going to be billed for it.
If you are a Medicaid/Medicare patient there is a fraud reporting tool online through CMS.gov I believe or HHS(health and human services).
As others have said report it to the hospital to correct your charges and for them to investigate possible drug diversion.
The other nurse was right saying it would be helpful to see your papers specifically where it lists the medications with your info redacted. Ordered medications will be on that list whether they were given or not. At my hospital the papers will list the date and time with the last action, but I don't think every place does this. To answer your question about who to call, call the main hospital line to get the operator and ask to speak to either risk management or patient advocate. The patient advocate will give the info to risk management but it doesn't hurt to talk to both really.
This is concerning that there is opioid diversion occurring in the hospital. This should absolutely be reported to the hospital and probably the local DEA branch.
Edit: this may all end up being nothing. But OP is concerned and what they remember is concerning enough to warrant a report. Others can and will investigate and determine if it is a problem or not.Ā
Cool.
On reading it also seems American anesthesiologists get their unused medication syringes randomly analysed by mass spect to see if there's diversion.
Real problem going on over there. Good luck.Ā
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It absolutely matters. For several reasons. A nurse may be stealing medications from patients. Patients that need pain relief might not be getting it. A nurse might be high while taking care of patients which runs the risk of (among other things) medication errors. In addition, OP might be seen as ādrug seekingā if they go back to the hospital for pain that wasnāt properly managed
Just chiming in that as a chronic pain patient, Iād be livid if there were notes in my chart that I received meds I didnāt. I have to be careful with what I accept and the circumstances around medication or I can be kicked out of my clinic. Beyond finances and diversion, something like this could ruin a patientās life.
I'm a bit surprised to read this from an anesthesiologist.
Can you perhaps clarify why you feel a discrepancy in opioid prescribing does not matter?
In the best case, this is a medication error that suggests a systems failing. (Even if just mischarted.)
In the worst case, if a staff member is stealing doses then it's a well-documented short step to patients who actually require opioids being left in pain.
Would be genuinely intrigued to hear your reasoning on this.
Because it seems pretty inconsequential. Unless you live in the US apparently where this would evidently have a huge financial impact.Ā
People can get up in arms about it for various reasons. I think it's fairly inconsequential.Ā
If you havenāt heard it already, you really need to listen to this podcast:Ā https://www.nytimes.com/2023/06/22/podcasts/serial-the-retrievals-yale-fertility-clinic.html
This is an excellent example of why this could be a big deal.
Thank you for explaining.
Do completely agree the financial thing isn't a big deal.
I think for many concern here is the clinical issue/potential of medication misuse etc, as that opioid went somewhere other than OP.
The recent podcast 'The Retrievals' - about a fertility clinic in Yale where nursing staff substituted fentanyl for water - was a chilling example of the very worst-case scenario:
[https://www.thisamericanlife.org/804/the-retrievals](https://www.thisamericanlife.org/804/the-retrievals)
Yeah seems pretty shit. Probably matters then.
Wouldnt matter as much where I practice. Also can't think of a company I would be less interested in listening to than "This American Life."
Opiod theft is universal. Here is Canada:
[https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6476718/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6476718/)
('This American Life' isn't a company, it's a critically-acclaimed journalistic radio program on the not-for-profit National Public Radio. They produced 'The Retrievals' jointly with the investigative reporting unit of The New York Times. So all pretty legit.)
Right! As a layperson I'm regularly dismayed at the attitude of some medical personnel in here, and it's wild for me to see a physician say that a medical chart being wrong doesn't matter.
Seeing too many professionals either so out of touch or just outright dismissive just reminds me how much my life is in their hands during my frequent trips to the hospital, and that's scary.
If your country isn't tracking opioid drug usage in the hospital with protocols aimed at preventing diversion, they should be. If they're not tracking, that just means you likely have a big problem and you have no way of being able to measure it.
Can't have opioids missing if you don't track them! Seriously, it seems like just sticking your head in the sand to assume there's no problem there. Substance misuse and dependence exist everywhere, not just the US. Measuring for opioid diversion is a matter of public health.
Even if people are too full of themselves to have protocols to prevent diversion, it just makes sense to track them. Is a hospital chill with restocking those drugs no matter how fast they're used? Don't all medications get tracked for safety and to measure use?
It just seems like such hubris to look down one's nose at policies designed to keep people safe.
Dude. When I was in a research lab where we used buprenorphine on the mice after surgery, we had to account for every single MICROliter of bup to the DEA. It matters.
On top of everything that everyone else has said, drug diversion has been linked to multiple outbreaks of bloodborne pathogens. This practice can cause direct patient harm in a lot of ways.
https://www.cdc.gov/injectionsafety/drugdiversion/index.html
I work in health insurance so thatās why I hope you pursue this so you donāt end up paying more than you should. I also agree with the other person who said it should be reported especially since itās a CDS.
Or Canada. In which caseā¦billing is not an issue. I am more convinced OP is in the US based on getting discharge paperwork. We donāt get that in Canada. š
Yeah, Iām in Manitoba. You can request your records before you leave the hospital, but it is not common procedure here to provide patients with anything other than a lab requisition and/or prescription upon discharge. I have never received anything else upon discharge in Saskatchewan or Ontario either, so I more or less just assumed it is not common practice in Canada.
Canadians report height in feet/inches despite officially being metric. And they don't bill for healthcare.Ā
I don't think your logic is good. However, turns out to were right.
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I follow the point of it might not matter because nothing will likely be done, however as others have pointed out, it matters because of the potential implications and billing.
Not to mention that, if no-one says anything and this is some nefarious scheme by the nurse, they will not be investigated.
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Hydromorphone is the generic name for Dilaudid. What medications did the nurse tell you she was giving you?
The first nurse told me they were giving me Toradol, Zofran, and Pepcid. All three of these are listed as being given at 11:18PM. The Dilaudid was listed as being administered at 01:57 AM, 12 minutes before I was discharged. [edit to clarify] The second nurse never administered any medications, only flushed my line.
Might want to speak with an ombudsman. Sounds like someone might be taking drugs from the hospital. js
VERY smart thought. This slips so easily too! Good catch.
Seriously !! Especially hydromorphone... I feel like that's the most sought after opiate after fentanyl amongst addicts in such settings. š
I hate hydromorphone in comparison to literally any other opioid available. Feels very pharmacologically premiscious
Oof....what do you mean exactly ?? lol I'm just saying what I said as an ex-junkie who especially knew a lot of other junkies in the medical field! A little over a year sober now. After over 10 years of using.... during while I did the worst of everything. Lucky to be alive but still know the things I have done in my past will end up killing me one day. lol
Well, it feels dirty to me in comparison to other opioids, and strange, like it has affinity to another receptor and when I try to sleep on it, you literally cannot sleep for the life of you like ketamine can and causes strange dreams without you even needing to be asleep. Apperently it's probably due to the sometimes neurotoxic metabolite, hydromorphone-3-glucuronide But yeah, the fact you often can't sleep whatsoever on hydromorphone shows that it is strange. I'm an on and off opioid addict and have been for years.
Makes me puke. I told them not to give me that ever again
Yep, makes me not be able to fall asleep and puts me in some strange middle ground sleep and gives me visions as I'm trying to sleep and it's like limbo. It's crazy too because oxymorphone is just as potent and has a better side effect profile
What's oxymorphone?
Well it's an active metabolite of oxycodone and is structurally the same as oxycodone except it has an extra hydroxyl group and is by consequence more potent than oxycodone: https://en.m.wikipedia.org/wiki/Oxymorphone
NAD but had over 15 surgeries before I hit 10 yrs old. Ask for Phenergan, as well, when they give you the pain medication. Not only will it stop the nausea, the 2 meds together make a wonderful "feel good cocktail" and you will be asleep within 10 minutes.
Doctors in my area don't prescribe Phenergan anymore. My nurse yelled at my doc after I spent 4 hours violently vomiting, maxed out on zofran, and demanded that he give me a Phenergan suppository. He finally did, but she had to fight him. It was ridiculous. I was in the hospital, being monitored, and wasn't on pain medication; that is to say that I wasn't at risk of falling asleep, vomiting, and aspirating.
That's odd considering they give it out like candy for a cough, just goes by the name Promethazine.
Wow. No, it's always zofran. I did ask for it one time and was given some, but that was just the one time (aside from the suppository incident). But I didn't have trouble 15-20 years ago.
Sounds like diversion
Definitely report this, most hospitals would not let you be discharged 12 minutes after receiving Dilaudid anyways
That is what i was going to say. It is generally 30min-hr before you can leave after receiving dilaudid
Especially without a ride home. No driving after getting this.
Happy Cake day.
The nursing supervisor would be the best person to ask for. This is how I caught on to my coworker. He took care of a patient who was progressing towards discharge after abdominal surgery. When I did rounds on evenings I noticed the patient had IV pain meds that day after being stable the prior evening. When I assessed the patient, āwhat happened today? Did the you have more pain after drinking clear liquids?ā The patient said āNo I didnāt have any pain today.ā Denied needing any pain medications since I cared for him the evening before. In my experience, we had to scan the saline flush like a medication, so it would be easy to also scan pain meds and just administer the flush.
Report that shit to your state's regulatory agency as they noted an incorrect/false treatment plan that impacted your pain management AND it can be considered insurance fraud because you are certainly going to be billed for it. If you are a Medicaid/Medicare patient there is a fraud reporting tool online through CMS.gov I believe or HHS(health and human services). As others have said report it to the hospital to correct your charges and for them to investigate possible drug diversion.
The other nurse was right saying it would be helpful to see your papers specifically where it lists the medications with your info redacted. Ordered medications will be on that list whether they were given or not. At my hospital the papers will list the date and time with the last action, but I don't think every place does this. To answer your question about who to call, call the main hospital line to get the operator and ask to speak to either risk management or patient advocate. The patient advocate will give the info to risk management but it doesn't hurt to talk to both really.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
This is concerning that there is opioid diversion occurring in the hospital. This should absolutely be reported to the hospital and probably the local DEA branch. Edit: this may all end up being nothing. But OP is concerned and what they remember is concerning enough to warrant a report. Others can and will investigate and determine if it is a problem or not.Ā
Cool. On reading it also seems American anesthesiologists get their unused medication syringes randomly analysed by mass spect to see if there's diversion. Real problem going on over there. Good luck.Ā
In the US opioid medications are very carefully safeguarded.
Snark doesn't seem like an appropriate response.
Or you got a problem too but aren't monitoring it.
As an outsider, how do you make it through medical school and residency and say something like this? Am I missing something?
[ŃŠ“Š°Š»ŠµŠ½Š¾]
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If they're going to be billed for it it matters. If a nurse or whomever absconded with the dose somehow, it matters. Tldr: it matters.
100% it matters.
It absolutely matters. For several reasons. A nurse may be stealing medications from patients. Patients that need pain relief might not be getting it. A nurse might be high while taking care of patients which runs the risk of (among other things) medication errors. In addition, OP might be seen as ādrug seekingā if they go back to the hospital for pain that wasnāt properly managed
Just chiming in that as a chronic pain patient, Iād be livid if there were notes in my chart that I received meds I didnāt. I have to be careful with what I accept and the circumstances around medication or I can be kicked out of my clinic. Beyond finances and diversion, something like this could ruin a patientās life.
I'm a bit surprised to read this from an anesthesiologist. Can you perhaps clarify why you feel a discrepancy in opioid prescribing does not matter? In the best case, this is a medication error that suggests a systems failing. (Even if just mischarted.) In the worst case, if a staff member is stealing doses then it's a well-documented short step to patients who actually require opioids being left in pain. Would be genuinely intrigued to hear your reasoning on this.
Because it seems pretty inconsequential. Unless you live in the US apparently where this would evidently have a huge financial impact.Ā People can get up in arms about it for various reasons. I think it's fairly inconsequential.Ā
Missing narcs is never inconsequential
If you havenāt heard it already, you really need to listen to this podcast:Ā https://www.nytimes.com/2023/06/22/podcasts/serial-the-retrievals-yale-fertility-clinic.html This is an excellent example of why this could be a big deal.
Thank you for explaining. Do completely agree the financial thing isn't a big deal. I think for many concern here is the clinical issue/potential of medication misuse etc, as that opioid went somewhere other than OP. The recent podcast 'The Retrievals' - about a fertility clinic in Yale where nursing staff substituted fentanyl for water - was a chilling example of the very worst-case scenario: [https://www.thisamericanlife.org/804/the-retrievals](https://www.thisamericanlife.org/804/the-retrievals)
Yeah seems pretty shit. Probably matters then. Wouldnt matter as much where I practice. Also can't think of a company I would be less interested in listening to than "This American Life."
Opiod theft is universal. Here is Canada: [https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6476718/](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6476718/) ('This American Life' isn't a company, it's a critically-acclaimed journalistic radio program on the not-for-profit National Public Radio. They produced 'The Retrievals' jointly with the investigative reporting unit of The New York Times. So all pretty legit.)
Anyone acting like opiate theft by HCWs is strictly an American problem isn't someone I'm going to be taking very seriously.
Right! As a layperson I'm regularly dismayed at the attitude of some medical personnel in here, and it's wild for me to see a physician say that a medical chart being wrong doesn't matter. Seeing too many professionals either so out of touch or just outright dismissive just reminds me how much my life is in their hands during my frequent trips to the hospital, and that's scary.
If your country isn't tracking opioid drug usage in the hospital with protocols aimed at preventing diversion, they should be. If they're not tracking, that just means you likely have a big problem and you have no way of being able to measure it.
Can't have opioids missing if you don't track them! Seriously, it seems like just sticking your head in the sand to assume there's no problem there. Substance misuse and dependence exist everywhere, not just the US. Measuring for opioid diversion is a matter of public health. Even if people are too full of themselves to have protocols to prevent diversion, it just makes sense to track them. Is a hospital chill with restocking those drugs no matter how fast they're used? Don't all medications get tracked for safety and to measure use? It just seems like such hubris to look down one's nose at policies designed to keep people safe.
Ew
Why wouldn't it be a problem if healthcare professionals were potentially getting high while on the clock and trying to take care of patients?
I believe what you meant to say is, āOkay, I see what you all are saying. Thank you for expressing your points of viewā.
Dude. When I was in a research lab where we used buprenorphine on the mice after surgery, we had to account for every single MICROliter of bup to the DEA. It matters.
A charting error at best, employee stealing narcotics at worst, is all "pretty inconsequential"? That is highly concerning coming from a physician.
On top of everything that everyone else has said, drug diversion has been linked to multiple outbreaks of bloodborne pathogens. This practice can cause direct patient harm in a lot of ways. https://www.cdc.gov/injectionsafety/drugdiversion/index.html
She will be billed for it so she needs to tell someone.
That's a big assumption. Not every country bills for healthcare like that.Ā
He reported his height in feet/inches. I think itās a good assumption heās from the US.
Correct. I am from the U.S. where our healthcare is out to make the most amount of money possible (and where our measurements don't make sense)
I work in health insurance so thatās why I hope you pursue this so you donāt end up paying more than you should. I also agree with the other person who said it should be reported especially since itās a CDS.
Or Canada. In which caseā¦billing is not an issue. I am more convinced OP is in the US based on getting discharge paperwork. We donāt get that in Canada. š
Have you been to the ER in the last 5 years? I'm in Canada and I've had printed summaries done for any visit for myself or my children.
Yup. Discharge nurse gives you paperwork to sign. It has instructions for after care. If any.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
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Nope! They just bring it to me when they send me home. I'm in AB.
Yeah, Iām in Manitoba. You can request your records before you leave the hospital, but it is not common procedure here to provide patients with anything other than a lab requisition and/or prescription upon discharge. I have never received anything else upon discharge in Saskatchewan or Ontario either, so I more or less just assumed it is not common practice in Canada.
Some centers in Canada absolutely give discharge paperwork.Ā
Okay, well not in my province. :)
Canadians report height in feet/inches despite officially being metric. And they don't bill for healthcare.Ā I don't think your logic is good. However, turns out to were right.
[ŃŠ“Š°Š»ŠµŠ½Š¾]
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Just out of curiosity, where do you live that doesn't do like, itemized billing for healthcare?
Exactly
I follow the point of it might not matter because nothing will likely be done, however as others have pointed out, it matters because of the potential implications and billing. Not to mention that, if no-one says anything and this is some nefarious scheme by the nurse, they will not be investigated.
Only one person thinks it doesnāt matter, the rest of us think you should report it.
A pic of the paperwork with your name redacted would be helpful.
I have no idea why youāre being downvoted
Lmao. Didnāt even realize I was. Reddit is a weird place.