Confessions of a Hospital Administrator: I Feel Your Pain...Pill
A former hospital administrator shares what he learned about opioid pain addicts in the middle of the night and how the ACA holds promise to make life easier for all nurses.
As a hospital CEO, I listed my home phone number in the admission kit for each of the three hospitals where I served. I invited patients to call me at anytime if they had a concern or problem they didn't feel was getting resolved. I did this because I had such confidence in the nursing staffs and House Sups to deal with patients, that I knew that I would not get many calls. And for the most part, this was the way the scenario played out.
The exception was the disappointed narcotic pain med patient seeking a refill in the ER. While I know I don't need to explain the drill to ER nurses, it was a learning experience for me. Of the phone calls I received in the middle of the night (always after midnight), 80 percent were from patients who were angry they could not get the pain pills they wanted in the ER.
Getting Fooled By Pain Pill Addicts
I'll admit, I was naive at first - I was sympathetic to their suffering (and remain so to their addiction). I was like the new family doc right out of residency I hired who wrote a pain script on his first day of practice for one of the area's most notorious doctor shopper. When advised about this patient, he looked rather shocked and said "Well, he sure fooled me."
It turns out, a lot medical scrip writers get fooled. There has been much recent data and attention on the increased use of prescription pain meds - I'm not going to restate what we all know. But two recent observations strike me as especially telling. Dartmouth economist Jonathan Skinner was recently quoted in a New York Times article about the rapid rise in overdose deaths among whites (turns out docs are more cautious in writing scrips for black patients, but that's a story for another day...) that: "It is like an infection model, diffusing out and catching more and more people." And according to The Association of Community Affiliated Plans, between 1993 and 2012, inpatient admissions for prescription opioid overdoses increased by 150 percent. ER nurses get to see those patients too on the way up to the floor.
A Gun in the Face
My late night calls from a narcotic pain med seeking patient always went through three stages. First (apology) the caller would say they were so sorry to wake me up in the middle of the night. The second (self-pity) was the longest part, which included a run down of the patient's medical condition and pain issues. I would dutifully explain that I was not a physician and could not tell the ER doc what scrips to write. I also explained that pain meds were highly addictive and the patient should consider the damage the meds could cause, including accidental overdose. Then the third stage (anger) would kick in. I would get yelled at and threatened with lawsuits. I would urge the caller to see their primary care doctor and whatever specialists were needed to resolve the cause of their pain. But it was obvious these callers mostly did not have underlying medical conditions for pain - they just wanted the pills, because they were addicted.
As inconvenient as it was for me to get rousted out of bed in the middle of the night, it paled to what nurses and other staff had to endure in the hospital. At one hospital, a staff member ducked out of a back door in the middle of the night for a cigarette. Rather than use the secure smoking area in a well-lit area in front of the ER, this staffer propped a door open with a rock in a dark courtyard. A minute later, a man stuck a gun in her face and marched her up to the main medical floor where the House Sup was summoned. She had to unlock the Pyxis machine and hand over all the narcotic pain meds to get him to leave. From that day on, wherever I served as CEO, nighttime and armed guards were standing operating procedure. Also, any staffer who was found smoking via a secure door got to come talk to me so I could share the same story with them.
I know that on any given night ER nurses are the first responders in this growing epidemic. Addicted pain pill patients take up an enormous amount of your time. The Huffington Post succinctly summed up the problem in an article on 1/25/2016: "Most agree on the causes behind the problem, citing uneven prescribing guidelines, marketing of the drugs by the pharmaceutical industry, few limitations on access to the drugs, economic factors and an inadequate number of treatment facilities for drug misuse, abuse and dependence."
Taking Care of Patients Outside the Hospital
Some hospitals have taken to posting signs in the ER that that no pain med scrips will be written. But a growing number of health systems and insurance companies are taking a more integrated approach, which is the often-unrealized benefit of the switch to value-based medicine under the Affordable Care Act. The days are gone where patients are discharged without support, knowing that if they returned the hospital would be reimbursed again (or not paid again, depending upon the patient). Hospitals are getting better at following-up with caseworkers, discharge nurses and social workers to stay in contact and support ER super utilizers - formerly called frequent flyers, which is now deemed pejorative. But you know the patients of whom I speak. NPR recently highlighted a program by CeltiCare Health Plan in Massachusetts to preventively deal with the growing opioid epidemic among its mostly 50,000 Medicaid members.
If you are unaware of what steps your hospital is taking to proactively manage population health to keep patients out of the hospital - ask. I think you will be surprised at how healthcare is changing right before our eyes. It is my hope for all nurses that the promise of reinventing healthcare will eventually make your job easier and more enjoyable.
Agreed. I finally learned that if I wanted to manage any problem in a hospital, to ask the nurses and as much as possible, do that. Nurses always came up with better solutions than I or my leadership team could figure out. I looked smart and the nurses, patients and medical staff were happier - win-win.
Our society has catered to this behavior for so long. People expect to be pain free when they come to the hospital. It is a part of that "right now" mentality that has developed nationwide. And now we have suboxone clinics, which are supposedly opioid addiction management centers. Ha. It's like trading one addiction for another.
I wish people would see that when you continually take these opioids just to get high, and then actually need them for pain after mvc or surgery, these medicines won't work any more.
Until nationwide standards are set, we as health care providers will continue to deal with this problem. I wish more administrators were as supportive as you are. I think if more CEOs took phone calls from these people or had to come into the hospital in the middle of the night to deal with this, our plight would be seen and we may actually get the raises and support we deserve!
I have a friend who was addicted to pain killers and went to one of those suboxone clinics. Yes, it did seem like WTH? You are just trading one addiction for another. Well, it took about 8-9 months and the suboxone no longer made him high. He said he just felt normal. He then tiered himself down and is no longer a user. Sure he still craves the high, but knows getting clean was hell. I have sympathy for addicts because I know happy people do not use drugs.
I have a friend who was addicted to pain killers and went to one of those suboxone clinics. Yes, it did seem like WTH? You are just trading one addiction for another. Well, it took about 8-9 months and the suboxone no longer made him high. He said he just felt normal. He then tiered himself down and is no longer a user. Sure he still craves the high, but knows getting clean was hell. I have sympathy for addicts because I know happy people do not use drugs.
I'm glad your friend has a good success story from the use of a suboxone clinic. I've just seen so many people around my area abuse the heck out of the stuff. I've never met anyone that's actually gotten clean off of it; I guess that's why I am kind of quick to judge the purpose of the substance. I also have a parent that abuses suboxone. If it can actually help people, I am all for it.
Specializes in Clinical Documentation Specialist, LTC.
What's so very frustrating for me, as a chronic pain sufferer from fibromyalgia, grade 2 spondylolisthesis, horribly painful idiopathic neuropathy, bone spurs in my neck and degenerative cervical disc disease, those who drug seek make it very hard for people like myself to get the relief they need. There are times I am in excruciating pain and probably should be treated in an ED setting, but I find myself not seeking help for fear of being labeled as a drug seeker. I feel as those like myself who genuinely suffer very real pain are punished because of those who just want to get high. Most physicians these days are scared to write Rx for pain meds. for fear of being taken out in handcuffs for abusing the system.
With all that said, I am extremely sympathetic to opiate addicted patients. Someone very close to me is opiate addicted and it breaks my heart to watch it. I know how addictive opiate pain meds. can be because of the way they make people who take them feel, and how hard and scary it is to try and get clean. My heart goes out to those who are dependent on them to get through the day.
ServantLeader
3 Articles; 42 Posts
Agreed. I finally learned that if I wanted to manage any problem in a hospital, to ask the nurses and as much as possible, do that. Nurses always came up with better solutions than I or my leadership team could figure out. I looked smart and the nurses, patients and medical staff were happier - win-win.