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| No. 20 | 
Sep 21, 2009, 01:42 PM
 Re: If an ER patient is Not Sick, are we still supposed to treat?
Right. Exactly my point. I'm so glad there are others who have the same observation. It does seem like it would be extremely difficult to stand up for the ideal principles all of the time. My fear is that given the current Legal Environment, we are eventually going to get into trouble for doing these common practices- it will get turned around on us. Ie: "If you knew I was misusing/abusing the Opiates, why did you continue to give them to me, you fed my addiction, ruined my life and caused me Pain and Suffering." Originally Posted by hherrn  Doing something detrimental can put you in just as much hot water as something that isn't indicated.
I agree. My point is that even though I know this, I do it. And, I believe alot of nurses do. I give medications that I don't believe are beneficial. Every drug has a risk/benefit ratio. I give medications that neither, I, nor the provider, would allow for our own family. ABX for a URI is a good example.
I don't blindly give every medication ordered. I frequently question orders, and get them changed. Most of my coworkers would consider me a good patient advocate. After I have worked with a given provider for a while, they generally consider my opinion worth hearing.
That being said, I pick my battles. I can't imagine actually questioning every order I believe innapropriate, or outright refusing. I know I am not alone in this.
I would love to work in an ER where everything I give is really appropriate. Where the providers take the time to educate patients, or, God forbid, simply refuse to give in and risk nasty feedback.
Or, Imagine this: Pt comes in with a pain complaint without objective findings. Provider checks the state registry to find the prescription hx. Provider asks if anything has ever worked for this pain in the past. "Oh, vicodin seems to help? When is the last time you had vicodin prescribed?" If the patient give misleading information, have the pt arrested and taken out in cuffs. I have seen this done, and that patient never came back.
If I ever have the opportunity to work in an ER that operates on principle rather than expediency, I'll sign up. I would really love to work in a department that does only evidence based best practices. Not an option where I live.  | | Advertisement Sponsored Links | | | | No. 21 |
Sep 22, 2009, 12:46 AM
Re: If an ER patient is Not Sick, are we still supposed to treat? Originally Posted by hherrn
Or, Imagine this: Pt comes in with a pain complaint without objective findings. Provider checks the state registry to find the prescription hx. Provider asks if anything has ever worked for this pain in the past. "Oh, vicodin seems to help? When is the last time you had vicodin prescribed?" If the patient give misleading information, have the pt arrested and taken out in cuffs. I have seen this done, and that patient never came back.
I'm just interested here...please clarify;
The pt was arrested for what charge?
Patients lie all the time, what justifies arresting them?
| | No. 22 |
Sep 22, 2009, 04:15 AM
Re: If an ER patient is Not Sick, are we still supposed to treat?
It is a little OT, but I found the statute. I gave that as an example, because I think it is a common example of a nurse administering a medication that is not indicated. 17-A MRSA sec 1108, copies provided here, makes it illegal for a person to
obtain or exercise control over a prescription for a scheduled drug as a result of
deception. “Deception” includes:
“Failure by a person, after having been asked by a prescribing health care
provider or a person acting under the direction or supervision of a prescribing health
care provider, to disclose the particulars of every narcotic drug or prescription for a
narcotic drug issued to that person by a different health care provider within the
preceding 30 days; or
Furnishing a false name or address to a prescribing health care provider or a
person acting under the direction or supervision of a prescribing health care provider.”
This criminal statute also abrogates the privilege for communications made to a
health care provider in an effort to obtain drugs by deception. And the statute allows a
health care provider to report a suspected violation to a law enforcement agency, with immunity for good faith reporting. | | No. 23 |
Sep 22, 2009, 08:41 AM
Re: If an ER patient is Not Sick, are we still supposed to treat?
The only person I've seen arrested in the ED was a frequent flyer who stole a prescription pad and went to town with it. LOL. She came in by rescue a few weeks later, and someone (not sure who, exactly) called the police, and they came in and arrested her. She had also tried to call narcotics scrips in over the phone, saying she was one of our docs. Unreal!!
Anyway, back to the topic ...
Most of our providers are of the style of doc #2, but some still do the #1 maneuver, and totally admit it's defensive medicine.
| | No. 24 |
Sep 23, 2009, 12:30 AM
Re: If an ER patient is Not Sick, are we still supposed to treat?
I think it's weird someone would come in with rhinitis for 30 minutes prior to arrival. It would take 30 minutes to walk to the car, drive to the ED, and park. Then you have to check in, wait for triage, if there is anybody else there who's really sick, I would think Mr. 98.9 would be waiting a VERY long time. Of course, if there was nobody there and that's why the doctor has so much extra time on his hands, it would make great sense.
He must've been really afraid of H1N1, to go through the hell of an ED visit for nothing... and within 30 minutes of getting the sniffles? Very odd... Seems he would've, at least, lied and said he'd been sick for a day or two.  | | No. 26 |
Sep 23, 2009, 11:59 AM
Re: If an ER patient is Not Sick, are we still supposed to treat? Originally Posted by mwboswell I'm just interested here...please clarify;
The pt was arrested for what charge?
Patients lie all the time, what justifies arresting them?
We had 2 frequent fliers arrested recently who had been hospital hopping using different names. Forgot which names they used where, got recognized ("hey, I thought your name was...) and buuuuusted. Charge was theft of service.
| | No. 27 |
Sep 23, 2009, 02:39 PM
Re: If an ER patient is Not Sick, are we still supposed to treat?
The sticky issue here is that EMTALA requires that you perform a medical screening exam. However, once you do that, you have duty. It doesn't matter whether you stabilize them under EMTALA, they are now your patient. So, for example, a patient comes in after falling off a bike with "roadrash". The doctor discharges them but nobody cleans up their scrapes or gives them adequate follow-up instructions. If one of those get infected and requires further care, you can still be liable. It may not be an EMTALA violation, but it can still be covered under state tort laws. So even if they don't have an emergency medical condition, you still have to provide the current standard of care.
| | No. 28 |
Sep 23, 2009, 02:42 PM
Re: If an ER patient is Not Sick, are we still supposed to treat? Originally Posted by MikeyBSN The sticky issue here is that EMTALA requires that you perform a medical screening exam. However, once you do that, you have duty. It doesn't matter whether you stabilize them under EMTALA, they are now your patient. So, for example, a patient comes in after falling off a bike with "roadrash". The doctor discharges them but nobody cleans up their scrapes or gives them adequate follow-up instructions. If one of those get infected and requires further care, you can still be liable. It may not be an EMTALA violation, but it can still be covered under state tort laws. So even if they don't have an emergency medical condition, you still have to provide the current standard of care.
but this is not the sort of thing the OP was asking about...
| | No. 29 |
Sep 23, 2009, 06:12 PM
Re: If an ER patient is Not Sick, are we still supposed to treat? Originally Posted by morte but this is not the sort of thing the OP was asking about...
Her questions is whether we have to treat someone who she feels is not sick. The answer to that questions is: yes. EMTALA, which she initially discussed, only requires that you stabilize a person. However, you still have to treat someone once you see them, because this is the standard of care. It doesn't matter whether you are in an ER or a doctor's office. Although sending a patient like the one in the example home would probably not be below the standard of care, you always take some risk with minimal treatment.
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