Ideas to avoid being wrongly labled

For one of my pain management patients to go to ER for pain crisis, they must call my office and speak with either doc, or myself. One of us is also, ALWAYS on call. If we triage them into the ED, one of us calls ahead and makes arrangements and will go ahead and give some orders.

It's time consuming, but it lets the patients know you are taking their pain seriously, and makes sure they are adquately treated in the ED.

I have often thought about a card system (I think it is a GREAT idea), I just want to make sure that when I have a patient in the ED, they REALLY need to be in the ED. If a patient is having only a mild increase in pain, they can often be given an extra doseage of their PRN or called in a stronger PRN. This saves them the "dreaded trip" to ER, free's up ED resources, and doesn't cost anyone a ER visit for something that really doesn't need to be there. Now, for moderate to severe pain, patients usually go straight to the ED.

Dave

In homecare, we give a wallet sized card to our clients stating they are a VIP patient of XYZ agency, so when they go to ER or hospitalized they can easily show to Social worker/discharge planner so homecare can be resumed

Why shouldn't the same thing be done for clients of pain clinics with notation to show to ER staff so coordination of care can be done.

Glad to see you practice this way!
When I did IV pain mgmt infusion cases fordocs at Thomas Jefferson Univ Pain Center, that was how they practiced; but another major teaching hospital pain clients, doctors were SO difficult to contact! Never anyone on call, just on "consult" during regular business hours...GRRRRRRRRRRRRRRR.

I could NEVER imagine sending a patient to ED or elsewhere, and NOT call ahead or make some sort of referral.

Yes, people know who we are, and what we do, but... Can you imagine walking in and saying "I take Methadone and Dilaudid for pain. Yea, and some Ativan for anxiety and oh... Zanaflex." And yea, I'm having major pain issues. So what if I have cancer.
With the drug abuse problem in our area, the would be laughed out of the ED. Subjective pain, yea right!

Besides this, I don't want an ER doc ordering Nubain or Stadol, when I have a patient on pure opioid agonists. Not everyone understands the balance that is required, and not all pain medications are equal. When they think enough of my skills to come and see me regularly, I am certainly not going to leave them hanging when they are sick enough to be in the ED or Hospitalized.

Dave, who needs to call in some orders... right now

So what IS the deal with nubain and stadol ordered with morphine? I thought they could not be given together, and once had a patient who got both and they seemed to cancel out each other- she got NO relief.

Stadol and Nubain are what's called mixed opioid antagonists. Basically, you get some of the chemical structure that is like MS04, Demerol, ect... But you also get a chemical structure that is like Narcan. You DO NOT WANT to give a Narcan like drug when you have a patient who is in a pain crisis, when already on opioid therapy (unless you're treating overdose, over sedation, ect...)

Just not a good mixeroo!

Dave

Crikey...this is so true. Great way to make somebody feel even sicker.

Thanks Dave, no wonder my lady was hurting.

giving nubain to a pt on chronic pain management will make em puke just as sure as narcan....they get really ****** as well....