Drug Companies Reach Settlement with Two Ohio Counties

Daisy4RN · Oct 24, 2019

Of course the fed gov is also responsible. The article states the DEA warned about the problem but what else did they do? Anything? And dont forget JC and other hospital/facility p/p re: patients pain (pain is whatever the pt says it is/customer service). The whole mess is ridiculous and sad.

kp2016 · Oct 24, 2019

My initial response to this was that The Joint Commission deserves a huge share of the blame. The notions that pain is the 5th vital sign, pain is whatever a patient says it is and that pain must be treated until the patient says the pay is acceptable to them is a huge part of the opioid epidemic. (Yes I realize I’m about to be publicly drawn and quartered by anyone with chronic pain).

As I looked back through the old policy statements and national public safety goals in relation to pain the JC actually denies ever saying that those were positions they endorsed. One “fact sheet” I found actually states those were positions recommended by the American Pain Society and that their (The Joint Commission’s) only position was that pain must be assessed.

Not exactly the way I remember it happening but it wouldn’t be the first time a widely held “fact” turned out to widely misunderstood.

Wuzzie · Oct 24, 2019

I think the biggest offender IS the federal government when they started tying medicare reimbursements to patient satisfaction. That's pretty much when every thing really went to hell in a lot of ways. Of course you won't be seeing any government institution taking any responsibility for it.

JKL33 · Oct 24, 2019

"Pain is what the patient says it is" -- That is a fine concept as a stand-alone. It's true, none of us need to stand around arguing about whether a patient is really in pain or arguing with the patient about how much pain it is.

The problem though is that there was never any attendant discussion around the fact that neither the report of pain nor the appropriate acknowledgment of it ever needed to dictate which particular thing was done about it. And we have totally ignored any of the other pain treatment modalities we were ever taught because people were being accused of "judging" and not abiding by the spirit of the idea of believing the patient and other such nonsense if they didn't provide strong meds to treat the pain. This played out as: The way to really prove you (doctors, nurses, etc) were believing and not judging was to offer the strongest thing possible for any report of pain.

JCAHO/TJC/Joint Commission and other organizations need to acknowledge that their standards do not play out the way that they portray them. This isn't just about pain, it's about a lot of the things they involve themselves in, and it has happened with enough things that it's time to own up. They should be made to be responsible for correcting misinterpretations of the standards and also to assess for over-implementation. That may sound weird but anyone in a hospital knows that if there is a standard about something, more is better and you have to have a goal of ten million percent so that you don't look like you weren't trying hard or were missing things you shouldn't have. This manifests itself in very wrong ways and makes almost a mockery of the whole original idea. For example, screening large numbers of people who were never meant to be screened for something. TJC is responsible for this. That should be part of their assessment: Are you implementing this the way it was intended? Instead, organizations are pretty much complimented for inappropriate implementation.

All organizations need to be held responsible for the wayward overkill-style implementation of their goals, standards, measurements.

Hosptials need to start getting demerits for not even *trying to think* when it comes to stuff like this. For example if they know there is a CMS measurement about time-to-pain-treatment of long bone fractures and if hospitals' response is to demand that every kid with a r/o fracture gets some kind of opiate/opioid/narcotic for it ASAP while still sitting in the WR?? They need to be cited for that. That has nothing to do with the spirit of the standard, which is to not let people lie around in pain with no pain treatment for major fractures.

It is time to start penalizing organizations for not trying to think, and for implementing trash blanket rules instead of reasonable implementation of the spirit of a particular standard. And also time to hold the original organizations responsible for not taking an active role in all of the above after they publish the rule, standard, or measurement.

Wuzzie · Oct 24, 2019

40 minutes ago, JKL33 said:
For example, screening large numbers of people who were never meant to be screened for something. TJC is responsible for this.

We had this very issue a number of years ago. There was an NPSG that required all admitted patients be screened for suicide risk. The suits in the big offices either misinterpreted it or thought "go big or go home" and decided all patients being seen in the hospital for any reason including all ambulatory patients will also be screened. They came up with these "awesome" questions (but but, there's only 4) that pretty much encompassed anybody just having a bad day (because who likes being in the hospital) and ZERO plan for what to do when they popped positive. You know what the result was? Huge numbers of perfectly normal people who weren't thrilled to have cancer being dragged down to the ED for a psych eval and getting put on 3 day holds or having to sign safety contracts. The ED social workers couldn't manage the numbers so they decided to try to train the ambulatory nurses on how to do full on suicide risk assessments which was bad enough because frankly, we sucked at them, but also anyone who had a full assessment was required to be seen by a mental health professional within 48 hours. Our psychiatrists were scheduling 9 MONTHS OUT with established patients. It was a huge mess and was finally pulled back when it became clear that it was not feasible and the risk management department explained to them the liability the hospital was taking on when we couldn't even follow our own policy.

JKL33 · Oct 24, 2019

16 minutes ago, Wuzzie said:
There was an NPSG that required all admitted patients be screened for suicide risk.

It ramped up again as of July 2019.

The NPSG is that patients with a behavioral health concern or complaint be screened x, y, z. This can be googled and read in very clear verbiage.

Guess who is getting screened?

JKL33 · Oct 24, 2019

It all relates back to the original topic.

It isn't news to any hospital nurse that the various measurements, recommendations, and standards are addressed in completely inappropriate ways, and that doing so is rewarded.

In researching the SI issue, I noticed right in official published discussion of the implementation how it was noted that (paraphrased here) "Some hospitals have been successful in screening all patients," as if this is in any way appropriate, and then with the same effect as if it were printed in 2-pt font: "but this is not necessary to meet the standard."

Come on. What do they think is going to happen?

And unfortunately it isn't just about increased work-load. That would be bad enough. But no -- it's about resources being removed from the area of focus that needs them the most. These inappropriate implementation behaviors are not innocent; they are not something for which people should be patted on the back or given a gold star or another award. The misapplication of ideas actually hurts patients--just like with your original topic.

kp2016 · Oct 24, 2019

38 minutes ago, JKL33 said:
These inappropriate implementation behaviors are not innocent; they are not something for which people should be patted on the back or given a gold star or another award. The misapplication of ideas actually hurts patients--just like with your original topic.

This is it in a nutshell for the screening questions and the opioid disaster.

Wuzzie · Oct 24, 2019

This article give a pretty concise synopsis of how we got into this mess. We have the WHO to thank as well.

https://www.mayoclinicproceedings.org/article/S0025-6196(17)30923-0/fulltext

Hoosier_RN, MSN · Oct 24, 2019

And all of this is what happens when persons who have never done 1 day of hands on, direct patient care, or who have been away from the bedside so long that they fit into my first category, are the ones directing, and making, policies with no real understanding of the very real outcomes. Years ago, when we really started the "pain is what the patient says it is, and we must treat it to their satisfaction or lose reimbursement", I commented that this would end badly. I was told that I was being negative by management...now they are singing a different tune, while many have suffered from this adage...many of us saw this coming from a mile away