dea/dept. of health regulations

[rnto?]

It seems every day I go into work the DEA or Dept of health or some other agency has created a new regulation that seems only to negatively impact patient care. pharmacies can no longer dispense C2 medications without the MD signing his/her life away, it seems. Now, the Dept. of Health wants us to reduce the use of benzodiazepines, so the DON was going around trying to get everyone's benzo's d/ced. The psychiatrist in our facility was really upset about this, as it's his first line (and evidence-backed first line choice) choice for acute delirium and a variety of other things. I just feel like all these agencies are making all these rules and it's negatively impacting the care we provide to patients-i can't tell you how many times in the past few months I've had to say to patients, "I cannot give you the pain medication because the pharmacy won't release it/etc"

What has your experience been?

[CapeCodMermaid, RN]

Unfortunately, some people have knee jerk reactions to regulations. Of course, benzos aren't wonderful drugs...BUT they are very useful and work wonderfully in some residents. Everything in LTC, and in life, is a balance of risk vs. benefit. If the benefits of the medication outweigh the risk and the side effects, and the docs write a note to that effect, the DPH can NOT make them discontinue the meds.

[elkpark]

I don't work in LTC, but I did work as a state regulator of acute care hospitals for my state and CMS, and I can tell you for a fact that all new regulations are created because of some abuse and/or bad outcomes that happened somewhere. No one in the state legislatures or any of these agencies is sitting around wondering how they can make life better for the elderly, mentally ill, etc. The regulations are all reactive, not proactive -- they happen because something godawful happened somewhere (or, more likely, more than one "somewhere"), and the relevant legislature or regulating agency sat up and said, "Golly! We've got to make sure that doesn't ever happen again!"

I saw this process play out many times during the time I worked as a surveyor. New regs are always written because someone, somewhere, was screwing up and the only recourse the regulating agencies have is to create new regs that apply to everyone. No one explains this, or explains the scenario that actually took place that led to the new regs, when they announce the new regs, but that's how it works.

(My state's mental health rules (which my team enforced, so I knew them v. well) include a rule that v. specifically says that locks on seclusion room doors on psych units must be wired into the fire alarm system and automatically unlock when the fire alarm is triggered. I used to literally cringe every time I saw that rule on the page in the book, because I knew what it meant -- somewhere, on some psych unit in my state, there had been a fire and someone had been left behind in the seclusion room, and been either killed or (just) badly burned.)