Our Guest: Brianna Graham MSN, RN, NPD-BC, ONC Diversion Prevention Specialist
This is a followup podcast with Brianna Graham. We talk a bit more about the intersection of the American Disabilities Act and Substance Use Disorder. We talk about when, if ever, it may be permissible to access the medical chart of an employee and Brianna shares her personal journey of weaning off multiple pain medications after many years of physical dependence.
Transcript:
Terri
Welcome back, listeners, to drug diversion insights. My guest today is the returning guest, Brianna Graham. I’m excited to pick up on a conversation that we had started previously. Brianna is a nurse and a diversion prevention specialist. She and I have done an episode before, and that topic was on the American Disabilities act and how that act may need to be taken into consideration when approaching diversion or suspected impairment investigation. So definitely go back and listen to that for some really good information on the ADA. And then you will also hear about Brianna’s professional experiences, which touch on many areas of healthcare. Actually, she’s got a wealth of experience. So welcome back, Brianna.
Brianna
Thank you.
Terri
I want to start a little bit, going a little bit back to the ADA. We didn’t really touch on. What are you allowed to ask someone during the hiring process? Of course, our focus is substance use disorder, and that’s what we want to try to mitigate those issues. So keeping the scope kind of narrow on that. What are we allowed to ask during the hiring process, if anything? And at what point in the hiring process?
Brianna
Yeah, once again, it gets very dicey. And once again, you want to best friends with your legal department, specifically employment law. And so again, it’s. The ADA is going to prohibit any discrimination against a qualified person with a disability in all stages of employment. So they possess the skills, experience, and education that will facilitate successful performance of the essential functions with or without a reasonable accommodation. So that’s the thing to remember. And so there’s stages of what you’re allowed to do. It’s during the application interview process, once there has been a job offer, but before they start, and then once they’re on the job. So it does break it down into three sections, separate areas. And again, the guidelines are going to be pretty vague because everything is an onion and a conundrum, quite frankly.
Brianna
But a person has a disability under the ADA if they have a physical or mental impairment that substantially limits one or more major life activities. If they have a history of an impairment that substantially limited one or more major life activities, or they are regarded as having such an impairment. You know, if you, as an employer, assume they have an addiction to drugs, whether or not you, whether or not the person actually has an addiction, and takes a negative employment action based on that belief, such as refusal to promote poor performance, raining or termination, that’s protected. So you have to be very, very careful. And again, that’s why you want to make sure that you absolutely keep legal at the forefront of all of this. Now, alcohol addiction and opioid addiction are treated differently.
Brianna
So alcohol addiction is considered a disability whether or not it’s current or past use, whereas opioid use disorder, that kind of thing, is a person is protected in recovery who is no longer engaging in current illegal use of drugs. Does that make sense?
Terri
Say that again.
Brianna
Does all that make sense as much?
Terri
No, I mean, can you make the statement again the difference between alcohol and.
Brianna
Absolutely. The alcohol addiction ADA is treated differently than opioid addiction. So addiction to alcohol is generally considered a disability, whether or not they used to use alcohol and no longer are, it’s still considered a disability. For anyone with opioid use disorder, other drugs, the person is protected under the ADA only as long as they are not currently engaging in illegal drug use. If they relapse, if they are doing those kinds of things, that they’re not covered.
Terri
Okay. I think I understand it’s still a substance use disorder, but alcohol is not illegal, I think, is kind of what it comes down to. Right. And so a substance use disorder could be, you could have it even though you’re legally prescribed things, but once you’re illegally using, then it’s different. Okay.
Brianna
Yeah. And again, you know, some of the guidelines I’ve seen says even if you have a legal prescription for an opioid, but you’re taking more than what is recommended, that’s considered legal use. So. But once again, this is just personal statements on this. I’m not by any means a legal expert, nor would I want to be mistaken for one, and I don’t even play one on tv. So.
Terri
I think the bottom line is it can be confusing.
Brianna
Very.
Terri
And so your hiring process, you want to have some defined processes in place if you’re going to ask questions, not just because you think this person needs to have this question asked, but you ask everybody, you keep it consistent, and then you have your processes defined as to what the next step is going to be. It always comes down to policies and procedures, I think, and staying consistent. So.
Terri
I was going to pivot a little bit. So if you had something else to say about that.
Brianna
No, I was just going to go into those three different categories of stages of what you can ask and when.
Terri
Oh, okay. Go ahead.
Brianna
Yeah. So during the application and interview process, whether it’s on the application or during that employment interview, when you’re, you know, you haven’t offered them the job yet, but you’re seeing whether or not they would be a good fit. The ADA prohibits all disability related questions, medical inquiries, exams, all of it, even if they are related to the job. So an employer may not ask an applicant about the existence, nature or severity of any disability, period.
Terri
Can you ask them if they would need any special accommodations? Just a general question.
Brianna
According to this, and again, I’m on the ADA website looking at this directly. It doesn’t appear so. So questions such as, are you taking drugs? Do you have a disability, illness or condition that will prevent you from doing this job? Have you ever been treated for addiction to alcohol, opioids or other drugs? Can’t ask it. Okay, so yeah, the next section here is the pre offer employment inquiries and addiction to alcohol. So, for example, this gives a scenario where a person has a job interview. His resume shows gaps in employment. The gaps are due to his addiction and alcohol recovery process. He calls the ADA and says, can the interviewer ask about gaps in my employment history? If I’m asked about the gaps, do I have to mention my addiction to alcohol? And so we can ask about gaps in employment.
Brianna
He can tell the interviewer that he had an illness. He’s fully recovered, excited about the opportunity. But if he’s asked a specific question about the disability, he must answer the question honestly, even though the question is illegal. If the applicant lies, it’s legitimate reason for not hiring. However, the applicant can then file a complaint for being asked a disability related question. So that’s where you have to be extremely careful. Yeah. So the ADA again protects a person in recovery no longer using any illegal drugs such as like heroin, cocaine, or use of prescription medications such as opioids or morphine. If the person doesn’t have a prescription, if they have a fraudulent prescription or if they’re taking more than prescribed, that’s still illegal. So, and the pre offer inquiries and medications used to treat substance disorders.
Brianna
So this is something that if someone is on mouds or medication assisted treatment, suboxone, methadone, vivitrol, they’re legally prescribed. And during an exam, let’s say if someone’s applying to an academy or to your place of employment, he has to go and undergo a medical exam as part of the application before an offer has been made. If he doesn’t undergo the medical exam, he’ll not be considered. So during the exam, the doctor asks, are you taking any prescription drugs? Even though this question violates the ADA, mark responds, yes, Mark, that’s the person in this scenario on the ADA website? Yes. Suboxone, does he have protection under the ADA? Yes, he’s a person with a disability. He has protection, medical exams and disability related questions that seek information about the mental or physical impairment.
Brianna
They’re prohibited, so the medical exam is requiring him to divulge information about the prescription medications that reveal previous impairment.
Terri
Most places, I would think, don’t do those exams until they’ve offered or agreed condition of employment. So that would fall under there. You’ve been offered, but you haven’t started yet.
Brianna
So now that takes us to the next session. Perfect segue, by the way, after the job is offered, but before they start, you can make medical inquiries, require medical exams, and ask disability related questions, provided that you do so for everybody in that job category.
Terri
Sure.
Brianna
And then you can ask questions about alcohol use, drug use, extent of use, or diagnosis of addiction to alcohol or drugs. They’re lawful. Okay. At this stage, the individual must disclose a disability if asked. So, for example, in this scenario, Sarah became addicted five years ago to opioids. After shoulder surgery, she obtained oxycodone legally, once her prescription ran out, she started recovery two years ago, which includes suboxone. Does she have to disclose that addiction? Well, she is a person with a disability. If she’s asked, she must be honest about her addiction. However, if she’s not asked and does not need a reasonable accommodation, she does not have to disclose that disability during that, you know, offers made haven’t started yet. Okay. And then once they’re on the job, they’ve started, they’re at work.
Brianna
They can only make disability related inquiries and require medical exams if they are job related and consistent with business necessity. So you can only ask them, you know, questions when it has. When you have objective reasons for thinking that the disability might be affecting or could be affecting job performance or public safety. So employees have to disclose their disabilities if they need to request an accommodation. Also, so, you know, a supervisor notices changes in behavior, sees the person sleeping at their desk, hears him slurring his speech on the phone, noticing he’s losing weight, his work productivity is lower. Speaking to the employee about his behavior and job performance, he tells her that he’s using heroin and needs to go to treatment. Well, yes. Does he have protection under the ADA? No.
Terri
Heroin.
Brianna
Exactly. Because it’s illegal use of drugs. So therefore, the employer has no obligation to provide a leave of absence. They can take whatever disciplinary action is deemed appropriate. And under the company’s drug use policy, they can be fired for using illegal drugs at work. But nothing in the ADA would limit the company’s ability to offer leave or assistance that, you know, they’re more than welcome to offer assistance, but they’re not required to.
Terri
But once they go through recovery, they are now covered under the ADA.
Brianna
There you go. Exactly.
Terri
So want to come back? Reasonable accommodations if you can make them.
Brianna
Yep. And then, you know, last chance agreement needs to make sure when an employee can be fired, an employer may offer a last chance agreement. The employer agrees not to terminate the employee in exchange for their agreement to receive treatment, avoid further workplace problems. Any violation of that agreement usually warrants termination because the employee failed to meet the conditions of continued employment. So that’s why those are pretty important things to make sure that you’re aware of when doing last chance, that kind of thing. But that’s where, you know, again, in diversion related investigations, if they are diverting and, you know, diverting for themselves to supplement their own current legal prescription or whatever, that’s still a legal use of drugs because it’s obtaining it fraudulently, taking more than, you know, prescribed or it’s outside of those parameters for lawful use.
Terri
Okay. So we’re fairly covered during an investigation if we suspect something, to ask those questions.
Brianna
And again, I mean, there’s lots of case studies and whatnot available, you know, through searches and whatnot of you’re never going to be able to plan for every contingency, but things of, you know, theft is still theft. And even though a person, for example, I saw several cases and, you know, again, your state is going to be different. You’re all of those different things. But there were multiple cases where the decision of the entity was held with, you know, upheld in court because, for example, a person with alcohol use disorder got a DUI and, you know, they’re like, but my alcohol addiction caused me to do this, so I should be protected under the ADA. And the ADA said, no, you know, it protects your addiction. It doesn’t protect you from the consequences of your actions.
Brianna
So, but again, you’re definitely going to want to make sure that you consult with your employment specialist. Okay.
Terri
All right. So that’s a good overview to keep in mind that some may not be aware of. Thank you for that. I’m going to change directions. You and I had talked not in the last podcast, but in a previous conversation and I had written down that my notes were a little cryptic. So hopefully you know what I’m talking about when I ask you the question I had on there that you could get around a HIPAA violation. So what’s frustrating for me is if I’m doing an investigation and I know that the staff member had come into.
Brianna
The ED.
Terri
For something. And so their chart is right there in terms of, you know, were they there for some sort of, are they shopping? Doctor shopping, you know, what was going on, but I can’t look. But it could give me the answers to many things that I need if I could look. But I have in my notes that you had said something about getting around a HIPAA violation during a theft investigation. Does that apply to a controlled substance diversion investigation? Is that what you meant, or.
Brianna
I honestly would have to one. I think it would likely depend on your state statutes, but as well as the HIPAA, I’m also not a HIPAA expert by any means. I ask compliance 100,000 questions a day to make sure that I’m doing things appropriately in my situation. The investigation that I was doing was related to a non controlled. And it was. And I had asked permission to access the employees medical chart in that instance, due to a theft investigation. And I was granted that permission. I told them exactly. Here’s what I looked at. Here’s how long I was in the chart, all of those things. Now, of course, they also have, you know, monitoring software, just like we do in diversion that could run an audit. That as well.
Brianna
But again, the more upfront you can be first, you know, the less you have to explain. But in this situation, I was granted that permission to access that. I honestly, a theft investigation is a theft investigation. So in again, personal opinion, which means nothing and holds no water whatsoever, I would think that the same would apply because, again, it’s still a theft investigation, whether it’s controlled, non controlled. But I would definitely double check that first prior to getting it into anybody’s chart. And honestly, most of the time, honestly, I’ve only ever had to access one employee chart. Most of the time, I’m interested in their patient charts on the floor, and I can typically find all I need there.
Terri
It doesn’t happen too often, but every once in a while, you find out, I was talking to someone a while back, and they had an incident, and they were looking at a particular person, and the diversion specialist said, and everybody knows that they regularly come into the ED.
Brianna
Yeah.
Terri
So it’s like, you know, I mean, it’s right there, but, yeah, I guess. I mean, because then you’re dealing with potential Ada or whatever’s going on with something, and you’ve got your hIPAA viable. If it’s illegal, but you don’t know yet.
Brianna
Yeah, but here’s the other thing, and this is something else. You really have to consider is part two protection, that part two protection that we kind of discussed last time, I think I’ve slept since then, so forgive me if I make that up in my head or dreamt it. Both could be possibilities. But the part two protection, the entire point of part two is that it was created to allow people to go seek substance abuse help without fear of criminal prosecution or negative employment action. So. So that can get very dicey if, let’s say, for instance, your organization has an inpatient mental health. If they are going there for treatment and you access those records, those are part two protected. I wouldn’t touch it. Would not touch it. Because HIPAA allows for certain. What’s the word I’m looking for? HIPAA allows for certain caveats.
Brianna
Like, if you’re doing this, then you can. Part two, it is an absolute red tape. Concrete, industrial strength, size and strength of red tape. You would then have to either get the employee’s permission. We all know how that would go to. You can request a special subpoena, and that would have to then go through a court hearing. The person would be notified, and then the court could basically decide, yes, you can have access to this, or no, you can’t. And there’s not really, to my knowledge, my very limited knowledge. I don’t know what kind of precedent has been set for that. But basically, you know, if you’re talking to your. Your legal team, they’re pretty much gonna tell you, like, try and find it other way, then. Then accessing their personal medical.
Terri
Yeah. So, again, if it comes up and you have the desire to get into somebody’s chart because you think it may help solve something, go to your legal compliance before you do anything, because I wouldn’t be able. You may be able to access it, but you may not.
Brianna
Yeah. I would never do anything on your own without them. Okay. All right.
Terri
Okay. So now I would like to hear about your story. So, when we had talked previously, you had surgery, chronic back pain. You were on several meds, and you said something that was very interesting to me, a particular type of therapy that you went through, and you ended up getting off, I think, 100%.
Brianna
Your meds.
Terri
Pain meds.
Brianna
Yeah. So I had a spine injury in 2014. I’ve had scoliosis my entire life, and I’ll try and make this short. I know it’s only a probably a 1 hour podcast, but I could. Less.
Terri
Less than an hour.
Brianna
I could talk about this for days, but I had a spine injury in 2014. I had scoliosis all of my life. It never inhibited me. I was very active. But you should not squat with a 50 pound bar on your back when you have a 36 degree curvature in your spine. And so I tried to dump the bar. Things happened. I ended up trying to power through it, and when I went down in the squat, I blew out five discs. So over the next six years now, mind you, I’ve been an ICU nurse. I’ve been an orthopedic nurse. I’ve done all the things. So I know how those surgeries have a stigma to them that patients who have these big spine surgeries typically don’t do well. Again, that’s the stigma, that it doesn’t necessarily mean that’s the reality.
Brianna
But, you know, for all intents and purposes, I tried to avoid that spine surgery like the plague. And I was a pain management patient for six years. I gained over 100 pounds. At my heaviest, I was almost 250 pounds, and I’m five foot three on a good day. And so I never missed work. I was not in a patient care role in that time, so I didn’t have access to picsis. So I wasn’t worried about anybody thinking that I was taking inappropriately. But I was on at least seven or eight different prescription meds, you name it, lyrica, you know, just Percocet. I was on 80 to 100 milligrams of Percocet a day, and no one. I was never impaired. I was so narcotic tolerant. I have had a total of 39 surgeries, and I just have a very high narcotic tolerance.
Brianna
I never slurred my words. I was never inappropriate. I was able to make decisions just fine. I was able to drive. You truly didn’t know I was on it, and I was on max doses of muscle relaxers. I was on enough tylenol to kill my liver. And so when you do that for six years, it is extremely difficult to control your pain. And I also am allergic to a lot of things. If you give me fentanyl, I will projectile vomit into the next room. I hate fentanyl with a passion. I’m not a fan of dilaudid.
Terri
But, in order to get off of those pain medications, because after surgery, when I could start moving again, I was still basically taking just about the same dose that I had been for six years. Because every time I tried to wean myself off, being the overachiever that I am, I tried to cut myself off too quick and would go through physical withdrawal. There’s a difference between a physical dependence to a drug and a mental dependence on the drug, I was never mentally dependent on it. But when I say that by cutting out two, I think I tried to cut out two Neurontin a day, where instead of taking four Neurontin a day, I was just trying to take two. The side effects of that are, wow. I literally would drench my clothes, and I literally would have to, like, take extra clothes with me to work.
Brianna
The dizziness, I mean, I fell over. You can’t really, you don’t want to fall over when you have a ten level fusion and eight rods in your spine. But, I mean, the side effects of trying to wean myself too quickly were an absolute nightmare. The nausea that. It’s awful. I can absolutely understand how people with addictions, they don’t even necessarily want to continue with the addiction. They want to avoid the sickness. The dizziness that I had. I remember somebody walking across the floor in my living room, and the vibration on the floor made me nauseous. I mean, it was awful. And so I can see how easy it would have been do go down that road, because for six years, I worth it. I was lonely, I was miserable. I was, I couldn’t move. I couldn’t live the life that I wanted to live.
Brianna
And you truly wonder, am I ever going to get better? Am I ever going to get on the other side of this? And I had resources, I had support, and so instead I got my master’s degree because I couldn’t do anything else physical. So I was like, well, I’ll just work on my masters and do that. And so I was still, you know, doing things, performing. Yeah, but I did what I could to keep myself going, and so I went, I asked, I said, I literally don’t know how to wean off these, and clearly I’m not doing it well. And so the physician sent me to, because we have a pretty comprehensive pain management program where they have, you know, behavioral specialists, nutritionists, physical therapy. Like, it’s a pretty great approach. Not just, we’re gonna throw pills at you, and good luck.
Brianna
And I had been in physical therapy, so that was already taken care of. But I went to the pain management psychologist, and she was the most phenomenal human on the planet. I have the absolute, utmost respect for her. And she was so understanding because I was like, listen, please understand, I don’t want to be on this stuff. I really don’t. I don’t know how to wean off of it where I’m not weaning off so fast that I have these horrible withdrawal symptoms. So she put me through something called EMDR therapy. Now, there’s lots of different therapies available. This is just what my path was. I had been in, like your traditional cognitive behavioral therapy for, I think, 17 years total over my adult life. And so this was something that I wasn’t nearly as familiar with. And I had heard amazing results.
Brianna
They use EMDR therapy for weight loss. They use it for pain management. They use it for all different kinds of things. EMDR. EMDR. So it’s basically like eye movement desensitization. It’s, oh, yeah, I’ve heard of that kind of thing. And it’s a rapid, so in my experience, and again, there’s different ways of doing EMDR. But you do have to have a specialized training in EMDR. You can’t just go to a dock in the box and get EMDR. But for mine, what I did was I held on to these two small vibrating disks, for better lack of a better word, and I looked at a screen with a light going across it and it would move very rapidly, and I just followed it with my eyes.
Brianna
And basically what it does is it shakes loose memories in your brain that, you know, kind of accesses, you know, behind the amygdala, and it accesses more deep seated things that cognitive behavioral therapy basically uses one side of your brain and memory recall. This kind of delves in far deeper. You know, there’s a difference between, you know, sweeping dust bunnies and getting down on your hands and knees and doing the deep cleaning. Okay, think of this as the deep cleaning and deep cleaning.
Terri
Just like burst out in tears for like some random, like, whoa.
Brianna
Yeah. And so, and I went through it. But the nice thing about it is if you can tough it out, you are through it so much quicker. It takes significantly less time because basically, again, you’re accessing both sides of the brain. So therefore you can just, you can get through it much quicker. I was able to get through it in six sessions, and I’m not going to pretend that they weren’t absolutely brutal sessions because there was repressed trauma that I would have been more than happy to never remember. But I no longer have things that come up that I’ll say, why did I react that way? Like, why did that bother me so much? And prior to this, I most certainly did. And so it really addressed the deep seated things.
Brianna
And my psychologist had told me at the time, she said, you’ve been one highway so long with these pain medicines that now your body needs to make u turn and your brain literally doesn’t know how. And so once I got through that EMDR therapy again, six sessions, I was able to wean consistently, and the neurontin was the hardest one to come off of that one. I still had ridiculous physical side effects of that, just drenching hot flashes. So we had to wean that one slower, but we had to do it literally a pill in a month, not a pill a week. And I was off of everything that I had been on except one muscle relaxer. But I was able to decrease that dose to the minimum, and I was off everything in less than a year.
Terri
So are you saying then that the withdrawal, the physical withdrawal symptoms that you were experiencing when you were trying to go off of it yourself before the EMDR, that was your body’s way of just kind of protecting itself and saying, we’re not doing this because there was an emotional component to it, then it wasn’t physical.
Brianna
It may not all physical, it may very well have been. But again, I won’t know that for sure because I was trying to wean too quickly as well. You see what I’m saying? So this was just a much more effective way and a much safer way to do it where we did, you know, they did the plan for me and I just followed it.
Terri
And dealing with your traumas at the same time exactly, is important for all, 100% when it comes to pain.
Brianna
But, yeah. So less than a year from surgery. So really the. By the time I really started weaning, I would say it was March.
Brianna
We were able to get an effective step down process in place. So march to July, I was off of everything. Again, one muscle relaxer that I’m still on to this day, but it’s the minimum dose. I take it twice a day. Other than that, I take two Tylenol a day and two leave a day. And that’s it? That’s it compared to 80 to 100 milligrams per cassette. And Tylenol and Aleve and Lyrica and, you know, pamela, you name it, I was on it. Yeah. Great.
Terri
Well, I mean, for you, thankfully, it wasn’t an emotional, that neurological type of addiction. So you were, you know, ahead of the game there. Thank goodness. Yeah, blessed with that. And then the physical side, which you’re right, I mean, I think everybody’s going to experience that. They’ve been on it long enough. That’s just the nature of the beast. And so you’re able to overcome that.
Brianna
Oh, I’m sorry. The other thing that people don’t, in my opinion, do a good job of explaining is that you will have a pain flare. And I think that’s another thing that keeps people from getting off of the pain meds is because even if you wean slowly, your body isn’t used to that and your body will amp up your pain, and so people go right back on it. And then I don’t think we do a good enough job of educating people of, it’s temporary, stick it out, you know, do whatever you can to get through it, except take more pain meds, and you will be surprised at how quickly you get through those pain flares where your body resets, you know, your pain receptors into a more normal, less elevated pattern.
Terri
Do you think therapy helped with that at all from a psychological perspective or is it all just physical?
Brianna
Possibly it did. Again, I won’t know because I went through therapy. So. So, you know, I’m. Of course, I think it helped, but I can tell you the pain flares, they were no joke. You know, they were no joke. They. They did not tickle for sure.
Terri
So do you recall, how long did they last? Are we talking hours, days?
Brianna
About a week. Yep, about a week. So there was a significant amount of ice packs used during that time. But, you know, you get through it.
Terri
Did it happen more than once, do you recall?
Brianna
Or was it one time? Pretty much with every major step down.
Terri
Change?
Brianna
Pretty much with every major step down. But, you know, some were worse than others. And I would say it was much worse in the beginning. Then as I continued to wean, it definitely got better where the duration was shorter, the severity was a lot shorter and less, you know, severe as well. So, yeah, it was, it was worth it. But I think if we did a better job of explaining that to people, it would help them be able to continue to wean. Right, rather than going, oh, I can’t take this, and jumping, because that’s why they’re.
Terri
Yeah, that’s why they’re on the pain meds in the first place, because they have pain. And so if you tell them you don’t need this anymore, they’re being like, yeah, I do. I can feel it. So, yeah, no, I 100% agree.
Brianna
Yep. Yeah.
Terri
It’s a complicated topic, for sure. And I thank you for sharing your story because I think the more we, you know, hear people’s real life stories and recognize that this is not a minor thing and, you know, pain for sure is a real thing. In your case, that was physical and some people said ends up being emotional, mental piece of it. But yeah.
Brianna
And I can also tell you that, you know, I had a very high pain tolerance and so for me to be at a ten, I would still look like this because I didn’t want to look weak. And so, you know, it’s very easy to look at a person who’s using their cellphone and saying well they’re obviously not in pain, they’re on their cell phone. No, that was my distraction. That was, that would, you know, help me not focus on the pain but focus on anything else. And you know, if a patient’s asleep, well they can’t be asleep, you know, asleep and in pain. Oh, but you can because those drugs will knock you out but it doesn’t actually fix the pain. So when you wake up you’re ready to crawl out of your skin.
Brianna
Another thing was, you know, in my, especially when I was in the ICU after my spine surgery, which is normal, you know, part of the process when you have a surgery that big, my, they would have me ask for my pain meds. They didn’t have them scheduled. Everything was PRN. I was so out of my mind with, you think I remember the last time I had pain meds. I can’t even physically see the clock. I may act like I am completely coherent to you right now, but I will not remember this conversation in ten minutes. And so when you have the patients have to ask for pain meds you’re going to play, you know, catch up rather than keep up. And so we would stop giving them everything all at once and then they have nothing again for 6 hours.
Brianna
Give them the muscle relaxer at two and the narcotic at four and the anti inflammatory at six. So you have much less peaks and valleys with your pain management and you have a much more consistent, you’re taking something every 2 hours and you keep it at a much more even keel. And if we don’t have to make the patients ask for it because by the time the patients ask for it then you go get it and you don’t get called into another patient room. Patients wait another half an hour, that kind of thing. It’s just a much better approach to.
Terri
And if you spread it out you have less chance of CN’s depression.
Brianna
Exactly.
Terri
Which that’s a very common medication safety. You see that happen because it’s all jumped together.
Brianna
Exactly. Yeah, yeah. So yeah.
Terri
Wow. Well that’s a thank you for sharing that. Yeah. Some clinical insights there, some empathy insights there for people and just insights in general as to somebody dealing with chronic pain and wanting to go off and what you had to go through.
Terri
Well, thank you. I’m sure that this was great information for the listeners, and I appreciate you spending your time with me, Brianna.
