code blog: tales of a nurse

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.

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.

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.

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!

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.

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.

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

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!

my comment is way TOO long.

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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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?

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...

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

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.

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?