Ideas to avoid being wrongly labled

Dave ARNP · Jan 7, 2004

For one of my pain management patients to go to ER for pain crisis, they must call my office and speak with either doc, or myself. One of us is also, ALWAYS on call. If we triage them into the ED, one of us calls ahead and makes arrangements and will go ahead and give some orders.

It's time consuming, but it lets the patients know you are taking their pain seriously, and makes sure they are adquately treated in the ED.

I have often thought about a card system (I think it is a GREAT idea), I just want to make sure that when I have a patient in the ED, they REALLY need to be in the ED. If a patient is having only a mild increase in pain, they can often be given an extra doseage of their PRN or called in a stronger PRN. This saves them the "dreaded trip" to ER, free's up ED resources, and doesn't cost anyone a ER visit for something that really doesn't need to be there. Now, for moderate to severe pain, patients usually go straight to the ED.

Dave

Home Health Columnist / Guide · Jan 7, 2004

In homecare, we give a wallet sized card to our clients stating they are a VIP patient of XYZ agency, so when they go to ER or hospitalized they can easily show to Social worker/discharge planner so homecare can be resumed

Why shouldn't the same thing be done for clients of pain clinics with notation to show to ER staff so coordination of care can be done.

For one of my pain management patients to go to ER for pain crisis, they must call my office and speak with either doc, or myself. One of us is also, ALWAYS on call. If we triage them into the ED, one of us calls ahead and makes arrangements and will go ahead and give some orders

Glad to see you practice this way!

When I did IV pain mgmt infusion cases fordocs at Thomas Jefferson Univ Pain Center, that was how they practiced; but another major teaching hospital pain clients, doctors were SO difficult to contact! Never anyone on call, just on "consult" during regular business hours...GRRRRRRRRRRRRRRR.

Dave ARNP · Jan 7, 2004

I could NEVER imagine sending a patient to ED or elsewhere, and NOT call ahead or make some sort of referral.

Yes, people know who we are, and what we do, but... Can you imagine walking in and saying "I take Methadone and Dilaudid for pain. Yea, and some Ativan for anxiety and oh... Zanaflex." And yea, I'm having major pain issues. So what if I have cancer.

With the drug abuse problem in our area, the would be laughed out of the ED. Subjective pain, yea right!

Besides this, I don't want an ER doc ordering Nubain or Stadol, when I have a patient on pure opioid agonists. Not everyone understands the balance that is required, and not all pain medications are equal. When they think enough of my skills to come and see me regularly, I am certainly not going to leave them hanging when they are sick enough to be in the ED or Hospitalized.

Dave, who needs to call in some orders... right now :)

**canoehead, BSN, RN** · Jan 7, 2004

So what IS the deal with nubain and stadol ordered with morphine? I thought they could not be given together, and once had a patient who got both and they seemed to cancel out each other- she got NO relief.

Dave ARNP · Jan 7, 2004

Stadol and Nubain are what's called mixed opioid antagonists. Basically, you get some of the chemical structure that is like MS04, Demerol, ect... But you also get a chemical structure that is like Narcan. You DO NOT WANT to give a Narcan like drug when you have a patient who is in a pain crisis, when already on opioid therapy (unless you're treating overdose, over sedation, ect...)

Just not a good mixeroo!

Dave

angelbear · Jan 8, 2004

Ya know I think I am going to talk to my MD about the card thing. We are talking small towns vill here care is so not coordinated. Luckily however my Md is very open and compassionate. He was very upset when I didnt recieve proper pain care because they did not contact him. I think he just might go for the card thing. Dave I like the way you coordinate your care I wish they did more of that around here. Even in the field I am currently in we have 4 different MD's that take call and ya get something different from everyone of them. Have people never heard of continuity of care? BTW dont ya just love that we have this site now?

fab4fan · Jan 14, 2004

Besides this, I don't want an ER doc ordering Nubain or Stadol, when I have a patient on pure opioid agonists

Crikey...this is so true. Great way to make somebody feel even sicker.

**canoehead, BSN, RN** · Jan 14, 2004

Thanks Dave, no wonder my lady was hurting. :rolleyes:

athomas91 · Jan 14, 2004

giving nubain to a pt on chronic pain management will make em puke just as sure as narcan....they get really pissed as well....

FutureNrse · Feb 5, 2005

I am a nurse I also have fibromyalgia and a host of other things. I have chronic pain it is ligetamit and there is medical testing that proves there are causes for the pain ie. severe arthritis. It seems to me there should be a way to be able to present in a pain crisis at an ER without being mislabled. My idea is that the primary physician could make up some sort of card we could carry. It could contain info such as DX's and what meds we are on and what works best for our pain crisis? I dont know if this is possible but that is my idea. The hope would be that it would exbidite our treatment and alevieate suspision. What do you all think.

I think it's a great idea. If nothing else maybe it will put a stop to nurses giving patients that look, you know the look, the one that says "you're nothing but a drug-seeker and I'm going to make it my mission to see that you aren't given anything but Toradol"

mwbeah · Feb 7, 2005

wrong posting.....oops