Frequent flier narc users

[corky1272RN]

The hospital system where I work is starting a program called the "Super user program". It is specifically targeting frequent flier pain seekers, but can also include patients coming in to the ER frequently for other issues.

The patients are "nominated" by staff and administration. There is a board of various hosp admin that will look at the patient's past visits, medical diagnoses, etc to see if they qualify for the program. Pts will be notified via certified letter. In the program the patient will have to find a pain management doctor (we have partnered with a local clinic for the uninsured). The pt will have to enter into an agreement with the MD for managing their pain, the physician will notify us. When the pt comes into the ER, we will only give the pt meds listed in their agreement.

It sounds like a good idea but I am just wondering if it works. Anybody heard of a program like this or experience? Did it work?

[Altra, BSN, RN]

I'm curious to see how this will play out with our core group of frequent flyers -- those inner city folks who are homeless (continually or intermittently), with psych and substance abuse issues, who are truly living off the grid. Social workers have spent the better part of their careers trying to get these folks enrolled in Medicaid and other assistance programs without success. Very curious if "Patient Centered Medical Homes" will make a difference this time around.

[Poochiewoochie]

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!

Yep. When I had my neck problem the pain doc prescribed MS Morphine, which, like the other narcotic drugs I had previously been prescribed did nothing for the pain. IMO the only thing that actually worked was a heating pad. I am so glad I never became addicted to them unlike other spinal surgery patients.

[ERksome]

It's sounds like a smart thing to try. Obviously frequent fliers aren't oorgetting 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

Thanks for sharing - great article!

[Esme12, ASN, BSN, RN]

I'm curious to see how this will play out with our core group of frequent flyers -- those inner city folks who are homeless (continually or intermittently), with psych and substance abuse issues, who are truly living off the grid. Social workers have spent the better part of their careers trying to get these folks enrolled in Medicaid and other assistance programs without success. Very curious if "Patient Centered Medical Homes" will make a difference this time around.

This is where the system fails. These patients have always used the emergency department as primary care for we are their only care.....these plans effectiveness depends highly on the surrounding demographic.

[nurse2033, MSN, RN]

This works great. It takes the pressure off of everyone to meet the Standards of Care in pain management. in general, once the patient sees that the hospital will be following their contract, they complain less and only show up when they really need it.

[DrLilith]

Yes, I remember this topic was discussed at a break-out session at a local fam. med. CME conference...one of the local hosp/clinic entities was trying such a program, their first group of patients was about 30-40 people. There were some growing pains and glitches at first, of course. Their most confounding/difficult case was a young adult who'd present in frank DKA, would still be conscious for a while and not allow any other treatment until she got her "D" medicine...at least every other week.

But even with these frequent fliers still *sometimes* getting what they wanted, that program had already saved the group MILLIONS of dollars in unnecssary tests/treatments/admissions in less than one year...on fewer than 40 patients. That made me sit up and pay attention.

[ERGirl83]

We have something similar, though we don't contract with a pain management doc (who in my experience are pretty much just legal narc dealers, it seems). And patients aren't nominated by staff. There is a program which keeps track of visits per month, and more than 3 in a month triggers inclusion. The policy is that we don't treat chronic pain in the ED. The pts are educated by case management, and provided additional resources.

The biggest problem we have is provider consistency. Depending on the day, and the doc, these patients are either sent on their way without narcotics (which they have been told will be the case, barring a verifiable new injury), offered PO Percocet in house plus a script for 5-10, or even given Dilaudid. Our medical director has tried to work for better consistency in orders and scripts but so far, it seems to be a crapshoot and that's my biggest issue with it. I have no problem standing my ground and saying no. But when I spend 5 minutes during my initial assessment laying the ground work for how we don't treat chronic pain in the ED, especially with narcs, and then I have to walk back in with a dilaudid syringe 10 minutes later, it really pisses me off. Not to mention incentivizes return visits.

It's such a drain on resources and morale.

Its funny to read about the chronic DKA'er, because we have one too.