This weekend we had a patient who had come in with chest pain. He was taken to the cath lab and was stented.
Normally this kind of patient would go home in a day or two if there were no complications. Unfortunately this patient had a big complication – he was an alcoholic. So by the time he was ready for discharge for his heart problem, his alcohol withdrawal had kicked in.
He is now on day 5 of his stay at the hospital. He spent at least 4 of those days in ICU which costs many thousands of dollars a day. He was still there Sunday afternoon when I left, and still on his Ativan drip. He was nowhere near getting transferred out to the floor.
I’ll cheerfully bet you $100 that even after all of the hell his body went through detoxifying from alcohol, he will get some good ‘ol ETOH from somewhere within an hour of leaving the hospital. You see, when he started getting goofy from DT’s, we started drugging him. Probably with some oral Valium at first, then when that didn’t work, we hit him with some continuous intravenous Ativan. Once the worst of the DT’s passes, we wean him off IV Ativan back onto oral Valium. When he’s stable on that, he gets discharged. I admit that I don’t know exactly how that works, because we just transfer them to the floors. Does he get sent home? Does he go to some alcohol treatment center? I have no idea.
I do know that some of our detox patients are in ICU because they have presented to the ER for whatever reason and request to be detoxed. They’ve had enough; they want off the sauce. Even the relapse rate for this is high; I often see the same patients come back over and over again. And those patients want to detox.
But when alcoholics come in for other health problems, they are detoxed whether they want to be or not. It’s for staff and patient safety, you know. People going through DT’s can be very combative and can be dangerous to themselves and others. So if they don’t get out of the hospital before the shakes hit, they automatically buy themselves a week’s stay… or longer.
This practice is downright counterproductive. If the patient comes in with a health problem, they should be assessed (as they currently are) for their alcohol intake. If it seems that the patient is an alcoholic, they should be counseled about it (“you should really stop drinking, you know”) and then be allowed to make their own decision. If they choose to keep drinking, they should be allowed to drink in the hospital. I know there are all kinds of possible ramifications to this idea, and I’m not talking about letting patients get sloshed. But if a beer or three a day will keep the DT’s at bay, then they get a shorter hospital stay. Which would taxpayers rather pay for? A case of beer or a $40,000 hospital bill?
Obviously it would not be a good idea for everyone, but I believe that it would be very helpful for some. I can’t tell you how many patients I’ve seen who come in for some minor surgery (appendectomy, chole, etc) and end up with all kinds of complications because we decide that they need IV Ativan more than they need a glass of wine or three at dinner.
They’re adults. It is utterly ridiculous how we healthcare providers think we should fix every little thing about a patient when all they need is a stent and a bus ticket back home.
I am Gina. I have been an Intensive Care nurse for 14 years. This blog is about my experiences as a nurse, and the experiences of others in the healthcare system - patients, nurses, doctors, paramedics. We all have stories!
Comments
Occasionally, we have beer in our fridge, ordered by docs for patients. Usually, though we just stick on them on PO/IV ativan until the risk of withdrawal has passed. Never Ativan drips since we aren’t an ICU. We screen for alcohol use at admit and anyone with reported high use goes on the CIWA protocol . We also do have an addiction counselor come and talk to the patient, though who knows if that does any good. I’m sure many of them go out and get drunk the moment they leave the hospital.
It’s never very good beer though.
added by Julia on 05.07.08 4:56 pm | Permalink
I’ve had patients ordered a beer too, usually TID c meals. I’ve also seen them put on alcohol drips once or twice, but we moved them to the ICU when it was that bad so I don’t know much about it.
added by Jenn on 05.07.08 8:58 pm | Permalink
In the 90′s I was an Intern for a San Diego trauma service for a month. I inquired about the order “beers with meals”, and was told it was simple preventive medicine.
Two or three days in a regular bed with cheap Buds vs. a week in the ICU (without changing their intent to go drink) seems a pretty good tradeoff.
added by GruntDoc on 05.07.08 10:07 pm | Permalink
We had some great ortho docs who ordered beer for patients post-op. (Ever had to initial a beer on a MAR? – Hah!) I even had one order a “vodka gimlet” – patient’s family brought it in a mason jar. I agree with you completely – no sense all that money and time if people don’t WANT to detox – and really want it.
Great post!
added by Linda on 05.08.08 8:46 am | Permalink
I appreciate that you did not judge the alcoholic. As medical professionals we encounter alcoholics and drug addicts every day and these patients can become untolerable. However annoying and difficult to take care of, we must remember that these patients are suffering from another disease besides the one that initially brought them to the hospital. It is important to keep this in mind while treating them. These patients deserve the same compassion we give others. After all, they are suffering from the only disease that tells you you don’t have the disease.
added by SamRN on 05.08.08 9:03 am | Permalink
Sorry, I’m no saint – I detest taking care of the alcoholics. I do not like being swung at, yelled at, or spit on. I do not like having my hand grabbed and squeezed so hard that it hurts. The reason I’m advocating that they be able to indulge their addiction is also so that they don’t pose such a danger to the very people that are trying to help them. If I wanted to be abused in such a way, I’d go work at some rehab somewhere. I’m glad that there are people out there that can be compassionate towards alcoholics. I am not generally one of those people. I simply avoid taking care of them.
added by geena on 05.08.08 9:13 am | Permalink
Then why even fix the stent-able problem?
Yeah, Yeah, I know they presented with the chest pain so the automatic function kicks in and we fix the problem. But if you are going to ignore one problem like their alcoholism…then ignore the presenting problem.
Being an ex ER nurse; I’ve dealt with this same situation: the patients stated desire to detox, the patients fear of detoxing, the circular door with these people. In my humble opinion if you don’t address the patients underlying depression you won’t get very far.
Just some random thoughts at an early hour; sorry about the nonlinear line of thought.
Steve
added by Steve on 05.09.08 2:18 am | Permalink
You also forgot to state that most of these patients have been guided to “disability” somewhere along their journey. So, we are paying for their $50,000 work up, yet again for “altered mental status” (may have had a stroke), with an ETOH of 250, or rule out MI (heart cath last month clean, but you can never be too sure). The hospitals continue to make money on these patients (medicaid) so they will continue to admit them, and though it p!sses you off, this is how they pay the bills. If I (with private insurance, working for a hospital) showed up in the ER with the same complaint for 3-10 months in a row, and had the same $50,000 work up each time, they would deny my claim and prevent me from being admitted. However, since I work for a living and pay medicare/medicaide to every skank who doesn’t feel like working, I kiss their butts, and take abuse from every low life who is suffering from “chronic back pain” (mind you every CT and MRI turns up normal) who shows up in the hospital on a monthly basis! They get their “pain med” scripts, take them all (or sell them) in the first 2 weeks, show up in the hospital for a week or 2, then leave with a new script. Repeat every month and you have their life! They want to revamp health care, take a look at this abuse!
added by Suzie on 05.09.08 7:03 pm | Permalink
my comment is way TOO long.
added by may on 05.10.08 7:25 am | Permalink
I always screen for drug, alcohol, and energy drink (caffeine) abuse when I see patients for the first time in the office. Sometimes, they are offended but I tell them that I don’t need a surprise combative patient call from the hospital when I can safely prescribe something to offset it if they are honest with me from the start.
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added by NPs Save Lives on 05.10.08 4:06 pm | Permalink
We used to be able to order beer, wine or some hard liquor for our patient’s meal trays (with a MD order). These were for people that did not come in to be detox’d. Interestingly, this was also ordered for patients who were going to be hospitalized for more than 4 days and who are used to 1 or 2 glasses of wine every night with dinner for many years.
These folks can also go through withdrawal, even from such a small amount of liquor if they are used to it over significant amount of time.
Anyway, the city we are in told the administration that if we were to continue with the ETOH with meals we would have to get a liquor license!. So now, we are back to chemical detox. A liquor license? where does the insanity end?
added by Donna on 05.14.08 12:59 am | Permalink
I’m thankful there are those out there with the compassion to see alcoholics along their healthcare journey. I’m not one of them. I understand it’s a disease and most have little control over the grip it has on them, but being hit, slapped, cussed out, and having a long list of things too disgusting to type yelled at me, I’d just as soon someone else take care of them because they challenge my sense of compassion. This is the reason my resume will never go to a rehab center. And like Suzie, I’m irritated by the “vague abdominal pain” pt who my tax tax dollars escort in and out of my unit on a bi-weekly basis, and “could he please have some more prn IV dilaudid because surely you don’t expect the po dilaudid to work…” The “abdominal pain” is so intolerable he needs every diagnostic and opioid available, but has no problem eating the Big Mac his girlfriend brought him and snacking on popcorn and candy while he plays video games and watches DVDs. Medicaid pays for his stay at the Dilaudid Hotel, while meanwhile I’m picking up extra shifts so I can afford the deductible on my dental insurance…
added by BeccaRN on 05.16.08 8:03 am | Permalink
I’m tired of wasting my time detoxing those who really could care less. CIWA, ativan, pleeeeze! Give them a drink and send them on their way. Stop wasting my valuable time
added by Debbie on 05.20.08 5:18 pm | Permalink
My pharmacy intership in a county hospital in San Antonio included dispensing generic BEER to the floor for pts to keep from withdrawels. We had cases of white cans with black writing -truly generic no brand beer. I thought this was normal for most hospitals- have not worked in one since school so maybe things have changed. It made perfect economic sense to me.
added by MO on 06.26.08 10:43 am | Permalink
I know a couple of nurses who’ve said that it’s normal to have beer and wine in their floor fridges for this very reason. I don’t think it’s the hospital’s responsibility to withhold ETOH from a patient who had no intention of quitting and is there for some other reason. I, too, have to imagine that dispensing cheap beer/wine to keep the DTs at bay is a lot cheaper than keeping them drugged until they’re released from their true admission complaint being resolved.
However, if you have a patient who’s drinking a fifth a day, or more, are a couple of beers going to be enough to keep them from detoxing? (I honestly don’t know, since I’m not a nurse.)
The last time I was in the ER after passing out at the mall, the guy in the room next to me was telling his nurses, loudly, how much he’d had to drink. Four fifths of vodka over the course of the previous three days, with little else consumed in the way of food or beverage. He had no intention of stopping his addiction, as he told the nurse–basically, he said he knew it was bad for him and making him sick, but it was cheaper than other things he might be addicted to and it wasn’t a big deal to him. If he was going to die, he figured that was out of his hands. I’m pretty sure that keeping him drugged up wouldn’t have much of an effect other than wasting the money of whoever’s paying for his treatment.
For the hospital told that they’d need a liquor license (oh PLEASE!! What kind of silliness is that?), would it have been possible, if the doctor prescribed or suggested alcohol, to have family bring it in to get around that regulation?
added by Beth on 07.13.08 11:24 am | Permalink
We used to have Everclear and beer in our Omnicell but the md’s would never order it so pharmacy got rid of it. Ridiculous. As a charge nurse I had a gentleman with cancer I observed smoking weed. He was in a great deal of pain, it was pallative.. I just told him to not let security (who was also our police chief) see him. He wasn’t hurting anyone, it helped his pain better than any other meds we were giving him, and it improved his appetite. Yes it was illegal, was it immoral – absolutely not, neither is giving an alcoholic a drink to prevent DT
added by de - rn on 07.30.08 1:26 pm | Permalink
There was me thinking nursing was a caring profession. How wrong and got to say GEENA you are a disgrace to your profession.
You never know what life might bring, would you have the same sad attitude if one of them patients was your family.
added by louise on 08.20.08 6:18 pm | Permalink
Our neuroicu uses vodka per feeding tube for our pts with heavy drinking history. Much better than CIWA protocol.
added by intern on 08.21.08 5:36 pm | Permalink
A lot of these patients also have liver issues, so if we are giving them alcohol what happens to doing no harm? I hate taking care of ETOH pts for the usual reasons, but have to remind myself alcoholism is a disease, not something people are choosing (some days this is very difficult!!, especially after seeing the same people on a monthly basis being admitted for the same issues)
added by ALLIE on 09.25.08 10:07 am | Permalink
There are those who abuse the system. Then there are those who fall in between. I can’t tell you how frustrating it is to be dismissed by ER nurses as another pill head/alcoholic. I work three jobs and have no health insurance. Working 80-100 hours a week, I assure you I do not have the requisite time to be a drunk– and I’ll never take disability/welfare. I was written off as an addict because I disclosed I was previously prescribed xanax. When I demanded a cardiac workup, they realized I had suffered a heart attack (CPK=5300, elevated Troponin). I understand your contempt towards those who make no effort to better themselves. But please PLEASE know that the decisions you make can kill. I have been repeatedly blown off and finally got a doctor’s attention at the 4th hospital. I turned out to be right; no one knows my body like I do. If you’re going to make that judgment on the patient before you, you better darn sure be right! (S)he could just be poor, or lower middle class, but otherwise respectable.
added by Eric on 01.01.09 4:52 am | Permalink
Ok so all of you who have an issue with dealing with alchoholics then you shouldnt be in the medical field. It is not a good idea to give someone alchohol while in the hospital. So what it costs people money. So I guess it is a good idea to give drugs to drug users also so that they will be comfortable. Maybe it doesnt always work to keep someone off of alchohol but for those times that it does then it is worth it. Get another professionif you cant handle it.
added by Dawn on 04.03.11 12:23 pm | Permalink
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