Frequent Flyers in the ED

petiteflower · Feb 19, 2004

We keep a log book, and medical records watches out too. They get treated, offered alternative medications (which they usually refuse) if they do not follow up. Like I said, we are very small, 3 docs and traveling docs on the weekend (who are required to follow our policies). It has helped.

RNin92 · Feb 19, 2004

We keep a log book, and medical records watches out too. They get treated, offered alternative medications (which they usually refuse) if they do not follow up. Like I said, we are very small, 3 docs and traveling docs on the weekend (who are required to follow our policies). It has helped.

Do you actually have a policy?

We used to have an "unofficial" log...but were told we were violating HIPAA rules. We are not supposed to even look up previous visits anymore!!!

What is an unwilling drug dealer supposed to do?!

petiteflower · Feb 19, 2004

Yeah, we do have a policy. And we haven't had any problems with HIPPA. But, it is kind of locked up--and if someone asked us for it, we would say (logbook, what log book?) I will have to bring that up to our HIPPA compliance officer and see what she says. And our doctors write an order all the time on these people to see old charts to see what they had been given in the past. So I think we are ok. And really, we are small enough, it isn't too hard to know who is coming in often and who isn't. It is medical records responsibility to notify the docs. So that kind of takes it off of us.

RNin92 · Feb 19, 2004

Yeah, we do have a policy. And we haven't had any problems with HIPPA. But, it is kind of locked up--and if someone asked us for it, we would say (logbook, what log book?) I will have to bring that up to our HIPPA compliance officer and see what she says. And our doctors write an order all the time on these people to see old charts to see what they had been given in the past. So I think we are ok. And really, we are small enough, it isn't too hard to know who is coming in often and who isn't. It is medical records responsibility to notify the docs. So that kind of takes it off of us.

Recognizing them isn't the problem. We would like to confront them when they say.."no...I haven't been here 5...6..12 times before!"

We are 200 bed level 2 trauma center. The ED is 20 beds-6 in fast track.

I'ld be curious to know what your HIPAA person says.

We are currently trying to work with our new CMs to come up with SOMETHING!!!

petiteflower · Feb 19, 2004

We are only a 5 bed ER. I would love to work someplace bigger like that. I would be happy to let you know what I find out. Watch for a pm from me.

Like I said. It's not the perfect answer, but it's a start. Medical records notifies us if the threshold was breached. The reason we started this was because of the State survey. They told us we had to have something in place to address frequent fliers requesting narcotics. We also still keep the handwritten log of ER visits, and the nurses enter the info in them (and that threshold is within one month if I didn't tell you already) so it really is fairly easy to get the number of visits in the last month.

RNin92 · Feb 19, 2004

We are only a 5 bed ER. I would love to work someplace bigger like that. I would be happy to let you know what I find out. Watch for a pm from me.
Like I said. It's not the perfect answer, but it's a start. Medical records notifies us if the threshold was breached. The reason we started this was because of the State survey. They told us we had to have something in place to address frequent fliers requesting narcotics. We also still keep the handwritten log of ER visits, and the nurses enter the info in them (and that threshold is within one month if I didn't tell you already) so it really is fairly easy to get the number of visits in the last month.

If you don't mind divulging...what state do you live in?

petiteflower · Feb 19, 2004

I live in Kansas

RNin92 · Feb 19, 2004

I live in Kansas

Well, Kansas sounds like a state with more on its agenda than Illinois...like perhaps what is in the best interest of the patient!

teeituptom, BSN, RN · Feb 20, 2004

Just consider frequent flyers as job security

give them their drugs, make them happy

much easier than losing sleep over them

not much you can do otherwise

Uptoherern, RN · Feb 28, 2004

tom, didn't mean to "flame" you in the other thread. Can't find the other thread. but it was along these same lines. What I meant before, and what I'll say again, is that I don't like wasting time on these people. They take up space that could be used for someone who is really sick. Kind of the same as the drunks. We have a policy now that if someone comes in etoh, they have to be placed on a monitor. ! Right now 12 of the 32 metro hospitals are on diversion. 2 others would be, but were opened by ems to "take their turn". How silly that we should have to have er space taken up by the theatrical drug seekers. Maybe wishful thinking....maybe wearing rose colored glasses, but if they no longer receive the narcs from my facility, why come there.?

too bad we have snoring (smellyfoot) drunks on monitors "sleeping it off" and the drug seekers getting their CT's (or whatever was appropo to their complaint) when the possible heart attack from down the block has to be diverted to a hospital 20 minutes away. :nono:

Uptoherern, RN · Feb 28, 2004

anyways...........i wouldn't really send them to your hospital. you are too far away. Then again........... :rotfl:

teeituptom, BSN, RN · Feb 29, 2004

you can keep yours I have plenty as is

and I just keep smiling