And so the day did finally come...

Ruby Vee, BSN · Feb 25, 2017

Many Physicians, Nurses Want Pain Removed as Fifth Vital Sign
It came earlier than I thought... but here it is. The returning of common sense.
I really, truly hope that the pendulum will not move too much another way. And I am sad that thousands of people died, and many others were orphaned, get incarcerated, lost everything as a result of this all-American madness.

"All American madness"?

The fifth vital sign business was a bit too much -- not only were some patients overmedicated, but the "customer service" model exacerbated the craziness.

NuGuyNurse2b · Feb 25, 2017

gotta get those HCAHPS scores high, you know.

KatieMI, BSN, MSN, RN · Feb 25, 2017

"All American madness"?
The fifth vital sign business was a bit too much -- not only were some patients overmedicated, but the "customer service" model exacerbated the craziness.

The "customer service" model's time is counted from now on, too.

If pain assessment would be mandated to include at least two components (i.e. "pain number" plus something else, like functional status, other VSs, behavioral characteristics, medication history), the irresponsible prescribing of opioids just because the patient says that he is on 100/10 pain will have to stop. A provider can only prescribe any medication with no indication(s) for so much and so long - early or later, in insurance or in pharmacy, it will be noted. All providers' precribing habits are closely monitored by pharm companies, insurance and peer committees - sometimes purely for profit-related purposes, but more commonly to assure compliance with guidelines and protocols. If a provider prescribes Namenda for too many patients, early or later there would be some questions of how many of these patient had serum B12 and TSH tested and how long ago, how many of them were on Aricept before (as it is first-line drug while Namenda is not), how many of them had MMSE done within the last year, etc. Not following the basic guidelines can get provider fired and reported to the Boards, especially if controlled substances are involved. So, if the "pain number" stops being the single indication to be considered while prescribing opioids, the number of orders and scripts will fall. Soon after that, there will be predictable generalized decrease in "patient satisfaction" scores. As it will happen approximately the same time all over the country, hospital industry, not wishing to lose money, finally wakes up and brings up the already existing data telling that "satisfied" patient doesn't automaticaly mean alive and well patient and that satisfaction scores do not have positive correlation with many types of outcomes. At the same time, hopefully, nurses and providers alike will vote with their legs and leave hospitals which put too much accent of HCAPS - former ones for not wishing to be treated as waitressing staff with additional function of distributing drugs, and latter ones out of fear for their licenses and careers. That will be the end of "customer service" story in healthcare.

It probably will take another couple of decades and another generation to accomplish but it got to be done. Only one question is, again, how many people are going to die tortured deaths before it happens.

And, yes, if a country of just 4.4% of the world population consumes 80% of the world synthetic opioids' supply, I name it "madness". Or "craziness", if one likes it more. Or, plain and simple, epidemy of abuse which has little to nothing to do with any legitimate medical needs.

Everline · Feb 25, 2017

Not soon enough, but better than never.