Help with Pharmacy issues paper

Nursing Students NP Students

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Specializes in Cardiac, ER.

Hello everyone,..I need some help with a paper I'm writing for my FNP program. I am writing about the misuse/abuse of opiates. I live in Missouri, we have no formal tracking for schedule III narcotics. I am currently working as an ER nurse at a Level I trauma center and see daily, patients who are "frequent flyers" getting scripts for Norco multiple times a month. Discussions from EMT's and fellow nurses at other hospitals often report the same patients visiting multiple other hospitals and urgent cares and receiving narcotics from them as well. Unless the patient uses the same pharmacy or medicare or medicaid they can fill multiple scripts and no one is the wiser.

I'm curious as to how other states are monitoring this, how providers and pharmacies can collaborate to fix this, and just any ideas on how we as care providers can stop this! Not all of the misuse is a criminal act. I often see elderly patients who bring in a bottle of Norco they were given by the other ER in town, a bottle of Hydrocodone/Apap from their pcp and a bottle of Vicodin from yet another ER, they are all from different pharmacies and they don't even realize they are taking a triple dose of the same med! Any ideas would be greatly appreciated! Thanks in advance :)

Specializes in ICU.

I don't know that you really need a formal tracking system for schedule III narcotics. I know this is a little more on the political side but the less the government is monitoring what I am doing, the better. In my state, certain OTC meds are monitored at pharmacies because drug dealers use them in meth labs. A very close friend of mine works on swat and drug task force and while this helps a little, it hasn't really shut down the meth labs in our county. It's just too hard to monitor everything. At some point people have to become responsible for themselves. And they need to be educated by their PCP's and nurses when they originally get the meds. I know my opinion isn't the popular one but the way they try to crack down on this isn't going to work and the only people it is going to hurt are those who really need the meds.

Specializes in Nephrology, Cardiology, ER, ICU.

I'm in IL

http://Www.pmp.org

Specializes in Cardiac, ER.

Thank you Heather,...Part of me agrees with you,.I would love to see more patient responsibility in all of healthcare,..however part of me also thinks that we as healthcare providers are in some part contributing to the huge addiction problem in this country. I remember a time when a pt would come to the ER after injuring an ankle playing football. We would xray the ankle and if it wasn't broken the pt would be told to ice/elevate, take ibuprofen and be assured he would feel better in a few days. Today that same non fx ankle pain gets a splint, crutches, a 2 week supply of Norco and a referral to an orthopedic doc! I'm wanting to incorporate into my paper a sense of responsibility of the healthcare team to do the best for the patient, which often means saying no, or at least prescribing a 3 day supply for an illness/injury that shouldn't take 30 days to heal! I'm sure I'm a bit jaded from many years in the ER, but I daily see docs write scripts because it's easier than the drama that comes along when they don't! And of course, there are those press ganey scores to worry about,...we have to make the patients happy to get paid! I often feel great frustration when I'm expected to play along with these chronic patients that I've seen four times this month for abd pain that has been going on for 3 years with no dx. These patients have been scanned until they glow and get the $10,000 work up monthly with no explanation for their pain, at what point do we as prescribers become at least partially responsible for the addiction we keep feeding?

Thanks again for your response! The real problem is there are too many lawyers in the world :)

Specializes in Emergency.

I live in a very small town, one small hospital, three pharmacies, everyone gets to know the problem pts real quick. It doesn't stop it, but it does make it obvious to all who is doing what. We have pts who drive two hours to go to another ER so that they can get a script, or go to a different pharmacies to have a script filled because they know they won't get what they want here. For the most part they get away with it unless one of the docs or nurses is also over there and recognizes them.... Always an interesting story.

I know I've read of city/county/regional registries of narcotic RX in the past for this very purpose. I'm sure the pt who are desperate would do the same thing our pts have done, and just travel to the next city/county/state/whatever to get the RX they want.

I thought the whole e-prescribe thing was suppose to fix this though? Does anyone use it to look up what the pt has filled recently? When I first started playing with it 2+ years ago, I could see all the meds my pt was on. Now that was at a cardiologist office, so we weren't seeing the pt with six oxycodone Rx filled in the past two weeks, but still it would work for that.

And from a philosophical perspective I agree that we should keep the government out of monitoring what we do as much as possible, but I also agree that we need to use the technology we have to provide better service (which includes not contributing any more than we have to toward the Rx narcotic addiction problem that is prevalent in our society today).

OP, Why do you believe it is appropriate to denigrate another profession? "...there are too many lawyers in the world."

People love to complain about lawyers...until they need one.

Specializes in Cardiac, ER.

multi10,..I really said that a bit tongue in cheek,...the lawyers are only doing what our laws allow and demand they do. In researching for my paper I have realized that I have a great deal of frustration over care given to patients just "to cover your butt". I frequently see very expensive, diagnostics repeated on patients who have no medical indication for these tests. We do them to make patients/family happy or to be able to document to the fullest that we did everything within our power to find answers for this patient. For instance we often see patients who have seen their pcp for abd pain. Their pcp, who knows way more about this person than we do, orders an US of the gallbladder. The ultra sound shows no stones but wall thickening. The pcp then explains to the patient that perhaps they have a poor functioning gallbladder, explains diet restrictions, prescribes meds and orders an out patient HIDA scan. The patient then goes to the ER stating they are having abd pain and they think it's their gallbladder, "but I just can't wait three days for this test they want to do". The patient gets an IV, labs and, depending on where their first US was done, a repeat US. We of course get the same results and explain that HIDA scans are not considered emergencies and cannot be ordered from the ER. We tell the patient to keep their appointment. If said patient complains enough, he/she will get admitted to the hospital, have a HIDA scan the next day and be scheduled for surgery. This process might save them 3-4 days, but costs 10 times what it would have cost if they had followed the advice of their regular doctor. I don't understand this. How is it that suddenly patients know more than the caregivers? I see the drunks that fall get CT scans often 3-4 times a month!! We are not doing the best for our patients by giving in and doing things that may make them happy. The same theory stands for narcotics. Patients get narcotics with no diagnosis that indicates a need. If the patients pcp refuses a narcotic script they can get one from the ER doctor. I don't understand how we as caregivers have been forced to push our professional opinions and give people what they want instead of what they need.

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