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:
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.
This is a horrible policy in regards to people who don't have medical insurance. If someone doesn't qualify for MA and has pain, there might not be a way for them to be followed by a primary care physician unless they live in an area where free/sliding-fee care is available to them.
I'm just not a fan of blanket policies, per se. I like this as a recommendation, but take it as it comes case-by-case, you know?
We are taking it on a case by case basis now. It's not working.
As far as the policy goes: 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:
Given that the emergency department is intended for emergencies, it seems to make sense that non-emergencies be dealt with differently. While you are right that there is a problem for uninsured, do you believe that the ER is the best solution?
On my last shift, a woman came in by ambulance because she had run out of Vicodin. Because there is no policy in place to protect doctors who don't treat complaints of pain, she was given vicodin. 6 to go. At a conservative estimate, her ambulance and ER bill were $1800, or roughly $300 a pill. She may well have been in pain. At a minimum, anybody who takes 6-8 vicodin a day and runs out is going to be in withdrawl.
My thinking is that the $1200 dollars we paid might have been better used elsewhere. If you were drwing up a budget for healthcare would you put away$1200 for 6 vicodin?
BTW- After she got home, she called and asked us to look around for her 6 vicodin, which she apparently dropped. I wish I was making this up.
Having worked ER for many years this should be standard poicy in ALL ER's. All experienced ER nurses and ER MD's will tell you how big a problem RX pain medication addiction has become. Acute exacerbation is different from abuse, as the policy states. But the problem's we are seeing in our society all are a result of the same thing. Lack of personal responsability and a personal code of conduct, and a sense of entitlement like no other generation has ever had. I know I am going to get blasted for this but read the policy first before blasting me and think first and realize all the abuse that goes on in the ER, if you are new to the ER don't even waste my time commenting because you have not seen enough to tell me how horrible I am, the other experienced ER nurses will tell you about the abuse of the ER as well. A child with a painful ear infection at 0300 I understand.
Specializes in ER, Trauma, ICU/CCU/NICU, EMS, Transport.
Having worked ER for many years this should be standard poicy in ALL ER's. All experienced ER nurses and ER MD's will tell you how big a problem RX pain medication addiction has become. Acute exacerbation is different from abuse, as the policy states. But the problem's we are seeing in our society all are a result of the same thing. Lack of personal responsability and a personal code of conduct, and a sense of entitlement like no other generation has ever had. I know I am going to get blasted for this but read the policy first before blasting me and think first and realize all the abuse that goes on in the ER, if you are new to the ER don't even waste my time commenting because you have not seen enough to tell me how horrible I am, the other experienced ER nurses will tell you about the abuse of the ER as well. A child with a painful ear infection at 0300 I understand.
Nicely said.
Key points:
1) Lack of personal responsibility (and accountability)
I think it's great. It gives the doc an out if they think the person is drug-seeking. The doc can always go ahead and prescribe narcs if they think it absolutely necessary.
Guest219794
2,453 Posts
We are taking it on a case by case basis now. It's not working.
As far as the policy goes: 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:
Given that the emergency department is intended for emergencies, it seems to make sense that non-emergencies be dealt with differently. While you are right that there is a problem for uninsured, do you believe that the ER is the best solution?
On my last shift, a woman came in by ambulance because she had run out of Vicodin. Because there is no policy in place to protect doctors who don't treat complaints of pain, she was given vicodin. 6 to go. At a conservative estimate, her ambulance and ER bill were $1800, or roughly $300 a pill. She may well have been in pain. At a minimum, anybody who takes 6-8 vicodin a day and runs out is going to be in withdrawl.
My thinking is that the $1200 dollars we paid might have been better used elsewhere. If you were drwing up a budget for healthcare would you put away$1200 for 6 vicodin?
BTW- After she got home, she called and asked us to look around for her 6 vicodin, which she apparently dropped. I wish I was making this up.