[BlueTang]

I was hoping to find some advice on this website about legal aspects and pitfalls for nurses and dealing with pain managed patients, particularly those that to me appear to be addicted. I work for a busy family practice environment where some of the docs have tried to work with chronic pain patients, but some appear more to be addicted than relieved of pain. I get very concerned about dealing with these pts as their number one goal seems to be the next fix.
These pts, particularly 2 I have dealt with, will stop at nothing to get their next fix...threatening to "freak out" either on the phone or in the office, and they are very manipulative. I do realize that to educate more is forever helpful, but at the same time, the nurse may feel the pain and abuse by the pt before the doctor realizes or takes the necessary steps to acknowledge the severity of the addiction vs the benefit of pain management. In addition, one of my doctors asked me to contact another doctors office to inform him that she was aware he prescribed percocet to her pt and to inform him that she was providing the pt with pain management as her PCM. Her purpose was out of concern for the pt as we received notice from the pts mom that she thought the pt was overdosing, however, just after I made this call, I realized this was at least a gray area concerning HIPPA requirements. In dealing with these pts, they are so argumentative, particularly without getting their RX for pain pills if the doc disagrees with the need for refill. I worry over issues of legalities as related to the pt overdosing and/or worst, the extensive documentation you feel is needed with dealing with these pts, the use and benefits of contracts with these patients. I know there are pain management websites but was hoping someone could point me toward training and/or websites that may be more related to providing assistance related to the above concerns vs just the patients feelings about pain.

[asher315]

I used to work in a pain mgmt clinic so I understand your concern. As far as HIPPA is concerned, as I understand it, providing medical information is allowed for the purpose of providing care. So letting another MD know that your dr is treating the pt as a primary care provider, I would think would be allowed. We used to send a letter to all MD's invovled in our pt's care (that we knew about)
a letter stating this and asking them not to prescribe narcotics and sedatives for the pt. As far as the pts go, I think many times the pts are more afraid of the pain that just needing a fix. (Most of them anyway). The American Society for Pain Management has a website and links that might be useful,http://www.ampainsoc.org Also the nursing org is http://www.aspmn.org. Hope this helps.

[earle58]

i don't consider the hippa regs a gray area when it's a clear-cut 'need to know'. think of the repercussions if the other party DIDN'T know and the pt overdosed. this is potentially very dangerous, therefore is not violating any hippa regulations.

leslie