An interesting policy

[Guest219794]

An intersting policy. Anybody think this is a bad idea?

http://www.ohiocountyhospital.com/och.nsf/View/EmergencyDepartmentUseofNarcoticsandSedatives

MEDICAL STAFF POLICY

SUBJECT:

Emergency Department Use of Narcotics and Sedatives

Ohio County Hospital (OCH) has adopted a policy relating to the writing of narcotic and sedative medication prescriptions by the Emergency Department physicians. Because OCH is increasingly concerned about the abuse of narcotics in our society, this hospital discourages use of narcotics except when absolutely necessary.

The following policies and practices are for patients seen in the OCH Emergency Department who, after a medical screening exam, are found not to have an emergency medical condition:

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    • Prescriptions for narcotic and sedative medications that have been lost or expired will not be refilled. It is the patient's responsibility to maintain active prescriptions with his or her primary care physician, specialty physician, or pain control clinic that have regularly prescribed these medications. Patients who have chronic pain will now only receive non-narcotic pain medications as temporary treatment.
      
      Patients who have frequent or multiple visits to the Emergency Department seeking relief from painful conditions will be considered to have chronic pain syndromes. Painful conditions include (but are not limited to) migraine headaches, back pain, pelvic or ovarian pain, dental pain, kidney stones, and fibromyalgia. In these cases, non-narcotic pain medication should be prescribed.
      
      ER Physicians are expected to work with any patient in trying to arrange appropriate follow-up care, but continuation of narcotics through the Emergency Department will not be done.
      

  In the event of an acute problem for which the Emergency Physician feels it is appropriate that a patient be given a narcotic or sedating medication (either by injection or by mouth), the Hospital requires that a driver for that patient be physically present in the patient's room before administering the medication.

  If a narcotic prescription is given for care of an acute painful condition, this prescription will be only for a small number of pills to last until the patient can follow-up with his or her primary doctor or specialist. Any patient returning to the Emergency Department for refills of said prescription will be given a non-narcotic prescription. Follow-up with a primary care physician or specialist for definitive and continued care must be the approach the patient takes.

  For any questions regarding the policy, you may call 270-298-7411 ext. 452.

[Altra, BSN, RN]

I think this is a wonderful idea. What concerns do you have?

[jRN2be]

Kidney Stones? That may be chronic, but there can be physical proof for that persons pain... Isnt that kind of harsh? Isnt the policy for patients that can be classified as pain seeking or drug seeking? HMMM... and isnt it against the law to keep a list of patients on what we call at my hospital a FF list? I dont like it at all!!!

[sjt9721, BSN, RN]

HMMM... and isnt it against the law to keep a list of patients on what we call at my hospital a FF list? I dont like it at all!!!

Keeping a list isn't necessary. A report of previous visit dates can be run from the electronic documentation system (if any), OR from the patient registration system.

[jRN2be]

What a waste of time to pull the pts MRs. I guess that hospital is going to do that for every person that comes into the ER with abdominal pain... headaches....... I dont think that is good pt care, but what do I know im still a student

[Altra, BSN, RN]

Kidney Stones? That may be chronic, but there can be physical proof for that persons pain... Isnt that kind of harsh? Isnt the policy for patients that can be classified as pain seeking or drug seeking? HMMM... and isnt it against the law to keep a list of patients on what we call at my hospital a FF list? I dont like it at all!!!

Yes, CT scans may confirm the presence of kidney stones, but after a patient has been scanned 4, 6, 8 times or more ... at what point does subjecting the patient to further radiation just to confirm what is already known become irresponsible and poor clinical practice?

What a waste of time to pull the pts MRs. I guess that hospital is going to do that for every person that comes into the ER with abdominal pain... headaches....... I dont think that is good pt care, but what do I know im still a student

There is no "list" of patients, or time-consuming "pulling" of medical records. When I add patients who have arrived into the electronic board of active ER patients, I know instantly whether this is the first time they've been to this hospital, or the 57th time, or whatever. A brief perusal of the records of half a dozen visits ... presenting symptoms, clinical impression/diagnosis, etc. ... would take a minute at most. Not taking a patient's history into account when prescribing treatment is irresponsible.

This policy, as I read it, does not classify patients, but conditions. And it sets a standardized protocol for treatment of symptoms, not unlike the accepted protocol for treatment of chest pain or any other condition.

Edited to add: I don't recall ever being *excited* about a hospital policy before!

[jnrsmommy]

I don't think that a blanket policy, especially regarding an individual's pain, is the appropriate answer. Just because someone has a chronic issue, doesn't mean that they don't have acute exacerbations of these conditions (Sickle cell comes immediately to mind). Telling someone that has probably been on a narcotic for years, who has probably built up some tolerance, that you are going to give them a non-narcotic, seems harsh to me. I'm not saying that the alternative med wouldn't help some people, but that the use of a narcotic should be based on an inidividual assessment.

Bet they will come out w/ another form for the nurses to fill out as well.

[jRN2be]

Ok so maybe I am still soft, and think that everyone who says they are in severe pain, are really. Maybe I will grow out of this.!!

[Altra, BSN, RN]

Just because someone has a chronic issue, doesn't mean that they don't have acute exacerbations of these conditions (Sickle cell comes immediately to mind).

I hear you on the sickle cell scenario. But patients with chronic conditions are poorly served by ERs - it is a different branch of medicine altogether. This policy may actually do the most compassionate thing for these patients by redirecting them back to their primary care and/or specialist providers where their long-term treatment, including plans for exacerbations, can be provided.

I applaud the forward-thinking management and medical staff of this hospital.

[Altra, BSN, RN]

Ok so maybe I am still soft, and think that everyone who says they are in severe pain, are really. Maybe I will grow out of this.!!

And I haven't said that they aren't in severe pain ... just that the management of their chronic painful condition belongs outside of the ER.

[zofran]

Although I don't work in the ED, this sounds like a great idea. The ED really isn't the place to manage chronic pain/dental pain etc.., and like other posters have said, directing these people back to the primary doc is the best thing. And docs can still give scripts for narcs but just a small amt until the person can get to their regular physician. I would be all for it.....would be good to hear from some ED nurses though...........

[cursedandblessed]

it's a great idea and it gives the physician's some back up for the ff's. pain is best managed with a combination of therapies from what i learned working for the spine docs. pt, massage, and whirlpools along with drug therapy.

while i understand that pain is supposed to be what the patient says it is, unfortunately, the drug seekers have turned our er's into their "connection".

as well, with the media coverage of celebrities od'ing on prescription medications, and the likelihood of lawsuits to follow, i can see such policies becoming the norm, rather than the exception.