Frequent flier narc users

Sun0408, ASN, RN · Mar 9, 2013

Sounds a lot like policing to me. How are you to do your job if you have to look up approved medications. Will you also verify they didn't get a rx earlier from the clinic and are now out. I don't see how this would work to prevent seeking?? If they are seen and treated by a pain management facility they shouldn't need the ED at all right? But as we all know seekers are looking for more and more, nothing is stopping them from injuring themselves or making up bogus "chest pain" or "abd pain" etc to get more..Is the hospital going to sacrifice high customer service scores that will soon affect reimbursement? Seekers also get surveys.

I don't have the answers, this is a huge issue in America and something needs to be done. Maybe it will cut down on the number of visits.. Keep us posted, I would like to know how it works out.

lovinlife11 · Mar 9, 2013

Sounds good in theory. I giggled a bit when I read they are "nominated" by staff, like an award. Lol! Anyway, keep us updated, I would also like to know how this turns out.

corky1272RN · Mar 9, 2013

The patients shouldn't be coming to the ER for a Rx refill :no: , but if they are taking tramadol at home for back pain then they aren't going to get dilaudid in the ER . If they injure themselves that is a different story . Seekers usually don't fill out surveys with satisfaction anyway (they didn't get what they want, it wasn't on time, it wasn't fast enough, etc). The nurse won't have to look up the meds that are approved, supposedly it will be in our computer system, and the ER physician will base his orders on the approved meds. The nurse will only follow the orders like usual. This definitely won't stop the frequent fliers seeking narcotics but hopefully it will deter them.

Sun0408, ASN, RN · Mar 9, 2013

I don't mean come to the ED for RX refill. If their drug of choice is hydrocodone 10's and they are out, what is stopping them from coming to the ED to get more of them because they used up their months supply before the month is up.. That's what I mean.

Altra, BSN, RN · Mar 9, 2013

I don't mean come to the ED for RX refill. If their drug of choice is hydrocodone 10's and they are out, what is stopping them from coming to the ED to get more of them because they used up their months supply before the month is up.. That's what I mean.

Pain management contracts generally spell out meds / dosing / refill time.

tigerlogic · Mar 9, 2013

It's sounds like a smart thing to try. Obviously frequent fliers aren't getting their needs-- addiction treatment, chronic pain, psych, social work, whatever-- met in the current system, right? And secondly they are wasteful in the system. A related experiment can be read about here: Lower Costs and Better Care for Neediest Patients : The New Yorker

SweetMelissaRN · Mar 9, 2013

I've heard of this being done. The pain management doctor treats the "normal" pain, but has set orders for any break through pain, which is what they normally come in for.

I love this idea. Like the other users, I'd love to know how it works!

That Guy, BSN, RN, EMT-B · Mar 9, 2013

I love it. We have pts that are on pain contracts. And they try and try to pull a fast one with us all the time. What is even better, is when the pain doc is in the ER ( usually hospitalist or family med doc ) and the pt comes in and says it is ok for them to get dilaudid every 30 minutes until they are better, and the doc hears them. Oh best show I ever saw.

TraceyMarino · Mar 10, 2013

Do you work at a critical access hospital, or hospital that receives rural health money? If so, that is what is behind this type of program. CMS and other government agencies look at your ER/urgent care charts, and sees how many visits are really issues that should be treated in primary care. With this big push for the Patient Centered Medical Home, hospitals are identifying patients who are overusing ER/urgent care, and trying to corral them into primary care. It appears that your hospital is implementing this with pain patients. Our hospital has been doing this for several years, and so far, it has helped some. If these patients are in a "pain contract" with a "pain specialist", they cannot receive narcs from any other provider, ER or otherwise.

I am fortunate to work in a very small hospital, and all of our providers are banding together to try and eliminate the overprescribing of narcotics. If you start referring patients to a "pain specialist", you will, however, notice a huge boost in oxycontin, fentanyl patches, and other high powered narcs in your community. Vicodin use will go down, oxy use or fentanyl use goes up. Sad but true!

Natural510 · Mar 10, 2013

Sounds a lot like policing to me. How are you to do your job if you have to look up approved medications. Will you also verify they didn't get a rx earlier from the clinic and are now out. I don't see how this would work to prevent seeking?? If they are seen and treated by a pain management facility they shouldn't need the ED at all right? But as we all know seekers are looking for more and more, nothing is stopping them from injuring themselves or making up bogus "chest pain" or "abd pain" etc to get more..Is the hospital going to sacrifice high customer service scores that will soon affect reimbursement? Seekers also get surveys.
I don't have the answers, this is a huge issue in America and something needs to be done. Maybe it will cut down on the number of visits.. Keep us posted, I would like to know how it works out.

Hospitals will also lose reimbursements for revolving-door visits, so in this case it will probably be addition by subtraction if it cuts down on their overall visits.

Esme12, ASN, BSN, RN · Mar 11, 2013

I worked with a system that utilized "Care Plans on File" that had specific treatment plans for frequent flyers so their care would be consistent and essentially narcotic used decreased almost by 40%. It worked but participation withe PCP's and pain clinics/MD's is imperative.