nammi, Nurse, General Practice, 03:51PM May 28, 2013
Diane M. Goodman
As any experienced nurse can confirm, dealing with patients exhibiting DSB (drug-seeking behavior) is particularly challenging. The nurse caring for a patient with this type of behavior typically feels powerless, out of control, and "challenged" by the patient's unique set of complaints and requests.*
Mention a drug-seeking patient to an ED or bedside nurse, and their stress becomes apparent. The patient's behavior, e.g. asking for specific medications by name, complaining of unrelieved pain, and insisting the physician be contacted repeatedly, typically escalates into an impromptu "war" between patient and caregiver. No one wins this battle, and solace is temporary at best.
Providing the nurse with an arsenal of tools for the drug-seeking patient may be the difference between experiences that become truly distasteful to those that are quasi-manageable (at least until the next visit).
Rule number one is to avoid developing an adversarial relationship in the first place. Validating the patient's pain as being complex and emotionally distressing will assist in keeping the patient at ease, as will having an interdisciplinary approach to their care. Keep the patient busy, especially with tasks that may improve pain awareness. Ask the patient to fill out a pain diary, noting when symptoms become more upsetting. Are the symptoms reflective of anxiety, or pain? Perhaps an anxiolytic is indicated rather than an opioid.
Pastoral Care (or a Patient Representative) can also be utilized in the plan. Ask them to see the patient for a brief visit, to discuss the experience of pain, as well as how pain has affected their quality of life. Support systems can be assessed, including how pain is interpreted by those closest to the patient.
Reinforce safety at every turn. Medications (especially when given parenterally) will NOT be pushed rapidly, but administered safely instead, as recommended by the product manufacturer. I've asked patients if they wanted to read safety information while I was preparing their analgesic (and saline) for injection, so they fully understand WHY medications are given slowly and monitored for effect.
Once patients understand they cannot bully their way into getting what they want, their behavior may change. For this to happen consistently, all team members need to be on the same page. Patients who are truly drug-seeking are masters of manipulation; if they sense a weakness in the system, it can and will be exploited at every turn.
*Stanford University Medical Center (ncbi.nlm.nih.gov/pubmed) found two specific behaviors were more predictive of DSB in the ED: reporting >10 out of 10 pain and requesting medications by the parenteral route.