Our Administration recently reprimanded several ER Doctors and Nurses. The reason- several patients with very very minor problems (ie: Very minor Contusions, Acute Rhinitis, Bumped Acrylic Fingernail, Superficial Paper Cut) had requested "Strong Pain Medicines" (ie: Morphine, Fentanyl, Dilaudid IM/IV and presciptions for Oxycodone, Hydrocodone to go) and didn't get them. While they didn't receive these medications due to the ER doctors didn't feel it was Clinically Indicated, the patients did receive appropriate interventions, such as X-Rays, CT scans, crutches, ice packs, elaborate wound care, Motrin, Tylenol, wheelchair service, etc.
The Reprimand/Verbal Policy by our Managment: All patients who ask for Strong Pain Medicines should get as much as they want, without knocking out their Respiratory Drive- even if it's not Clinically Indicated. Rationale? "Customer Service"..."Happy Customers are less likely to complain and less likely to Sue." "Give them all that they want." Might sound unbelieveable to some of you, to others maybe I sound callous, but for me it brings up Ethical Questions, the Hippocratic Oath & the Ethics of Business Practice.
The Question: Is this Legal or Ethical? What about the Hippocratic Oath? "Do No Harm"? Are we harming these people by giving them Medications that aren't clinically indicated, or are we harming them by allowing them to "Suffer" from Contusions, Sinusitis, Broken Fingernail, etc without the benefit of Opiates? Should we do interventions (medication and non medication) that aren't Clinically Indicated just because patients ask for them, just to make them happy? Are we monopolizing business from other Hospitals by doing this?
To note, our ER already has the unspoken policy of "give the customer whatever he or she wants", even if not Clinically Indicated, in terms of everything else, and our Community knows and expects this. For example, a young and very healthy patient had a superficial paper cut that we couldn't even see, but we did all she requested, wheelchair service, Irrijet Wound Care, Bulky Dressing, Vicodin Orally and Presciption, Meal, Refreshments to friends in Waiting Room, Personal Phone calls to concerned friends and family. No kidding, this is typical AND EXPECTED BY MANAGMENT at our facility.
Also what I see that is detrimental with this practice is that our ER staff is overloaded with the Customer Service Demands of the not-sick patients, and hence Critical Care patients don't get the care they need. Critical Care patients can't complain, while not sick patients can complain and ask for unlimited things. And our management, not being Clinical Practitioners, don't see the reasoning of this.
Specializes in Flight, ER, Transport, ICU/Critical Care.
Oh yeah - I forgot.
Where are you? - What would these complaints be worth? my back has been hurting lately and I have a toothache, a migraine, a really wicked hangnail, my TMJ has been acting up, my IBS is so painful, my cat bit me and it really hurts, I pulled my neck and now it really hurts and I've got blisters from my high heels shoes and the new tattoo is burning so bad I cannot stand the pain. Oh yeah - it really hurts when I pee.
Oh yeah - I'm allergic to tylenol, motrin, toradol, morphine, compazine, steriods and benadryl.
The only thing that helps is - dilaudid, phenergan and oxycontin.
And I know my way to managements office and I have rights!
My opinion is that they are promoting unethical and illegal behavior by facilitating delivery of controlled substances to treat paper cuts. Unethical because the patient is being allowed to dictate treatment, not the physician. Illegal because controlled substances are being prescribed inappropriately and administered irresponsibly.
BTW, your hospital is probably responding in this way to get more business.
The inherent problem with this approach is that drug seekers will come to your hospital for customer service and not health care. One approach is to give the administration what they want. In other words, let the 'customers' have IV drugs, but then let them sleep it off before they can safely go home. Then management will be unhappy that there are no ER beds. Then they will have to decide whether to deliver medical care or deliver controlled substances, causing potential harm to people when there is no clinical indication.
There is only one person that gives the IV or pill. If you happen to be that person, please remember that you do not have to give a med if it is against your best clinical judgment. Ask your supervisor to give the med. Believe me, if you gave a med and a patient had an adverse reaction, this same 'happy customer' would be first in line to sue you.
All of these complaints would receive very very liberal IV Opiates, then a prescription to go. The typical Opiate order would be an initial moderate dose of say, Morphine 6mg IV or Fentanyl 50mcg IV, then titrate every 5 minutes as requested by patient. Doctors want the patients to go home in very little, ideally NO pain. The TMJ, Tattoo and the Blisters may get IM Shot, usually Morpiine 10mg IM, or some doctors (the one's who disagree with the liberal Opiates policy) give PO's in the ER, for example Vicodin 2 pills or Percocet 2 pills; then a prescription to go. The proponents of the policy believe and teach our staff that patients should not go home in pain, even if a relatively minor complaint, such as an invisible contusion, if the patient says the pain is 10/10, then we are to treat it as 10/10. The Hospital worries about bad federal ratings, complaints, lawsuits and potentially bad media that they believe will be caused by allowing someone to go home in any pain whatsoever. The quote cited most often is, "Pain is what the Patient feels it is"- I believe that quote is often used by JCAHO standards as well?
To note, compared to other hospitals I have worked in, all of which have had much higher volume than this current, I have never given so many Opiates in my life! Also, this current hospital has a vast majority of patients who ask for Opiates and will cause big problems if they dont get them. At the other Hospitals where they're not routinely given in the same way, my patients with Lacerations, Blisters, superficial contusions, etc., never even asked EVER. So I believe our Hospital's current policy has CREATED the situation in which Liberal Opiates are EXPECTED.
I want to know, how are the same complaints above treated in your hospitals? For example, an uncomplicated Cat Bite, Superficial Abrasions, etc...are they given Opiates like our patients are? Is my Hospital taking the Pain Managment too far, too free of any Critical Thinking, or is what we're doing the "Right" way, the way JCAHO, CMS, DEA and other agencies want us to do?
Where are you? - What would these complaints be worth? my back has been hurting lately and I have a toothache, a migraine, a really wicked hangnail, my TMJ has been acting up, my IBS is so painful, my cat bit me and it really hurts, I pulled my neck and now it really hurts and I've got blisters from my high heels shoes and the new tattoo is burning so bad I cannot stand the pain. Oh yeah - it really hurts when I pee.
The ER Lead MD and Nursing Manager of our Department stated that we- MDs and RNs- are to give pain medicines in this way. The subject was reinforced at the last Department Meeting.
Tell them to go pound sand. They can give the medication if they want but your nurse manager cannot force you to give medications.
This post gave me chills!!!! Let me begin by saying....GET OUT OF THERE!!!!!! I was a Medical Assistant working for a physician who prescribed entirely too many narcotics however, at that time as UNLICENSED assistive personnel I was COMPLETELY ignorant of medical law and ethics! This was my first job as a Medical Assistant therefor, his way of practicing medicine was completely normal in my opinion as well as the remaining Medical Assistants within our office. After acceptance into clinical for nursing school, I resigned from my position. One week later, I came to the office to collect my things and was met by the DEA!!! After a 1 year investigation, The physician, a nurse practitioner, 3 medical assistants, and an LPN were ALL indicted on 88 counts ranging from conspiracy to prescription fraud. Initially the physician blamed his entire staff and claimed he had no knowledge of what was going on in his practice for the last 10 years. Fortunately, the government found this information to be false HOWEVER, wanted to hold the entire staff accountable for their actions although we only carried out orders or duties that were delegated to us by the physician! There are NO LAWS of DELEGATION in black and white when it comes to the state of Louisiana and the MEDICAL PRACTICE ACT.....TRUST me...I found this out the hard way!!! Medical Assistants work under the DIRECT supervision of a physician and now, I see why! Prior to the indictment I was completing 3rd level which included laws of delegation within the Nurse Practice Act.....it is VERY CLEAR what the NURSE must do when delegating a task to Unlicensed assistive personell! Sadly enough, this DID NOT matter! The jury would not have been instructed on laws of delegation....ONLY laws set forth by Louisiana State Board of Pharmacy, DEA, etc. If we had chosen to go to trial, we would have LOST....hands down!!!! We all had to except a plea that would ENSURE we would not spend 10 years in prison away from our children and families!.....REMEMBER....this is the FEDERAL GOVERNMENT!!!!! You can't imagine what this has done to all of the families involved....we were all GOOD people, GREAT medical assistants doing what we were told to do by our physician.
My point is this.......you are an RN!!!!! An RN is held accountable LONG before unlicensed personell!!!!! The fact that you are only doing what you're told to do WILL NEVER hold up when your indicted by the federal government!!! As an RN, you know that if there is EVER a slight feeling that you may suffer consequences of making a decision that may be illegal or unethical......DO NOT do it!!!! You need to get out of there immediately.........It is also your responsibility as an RN to REPORT any facility who may be practicing unethically or illegally otherwise, you may become part of the Conspiracy.......and CONSPIRACY is EXACTLY what this is.......You only have to know about it to be a conspirator!!!!! And trust me, the only person who has YOUR back is YOU....make no mistake about it!!!!!! I've learned quiet a bit about Medical Law through this journey! I hope this information helps as I only wish it were available to me 3 years ago!!!!
This post gave me chills!!!! Let me begin by saying....GET OUT OF THERE!!!!!! I was a Medical Assistant working for a physician who prescribed entirely too many narcotics however, at that time as UNLICENSED assistive personnel I was COMPLETELY ignorant of medical law and ethics! This was my first job as a Medical Assistant therefor, his way of practicing medicine was completely normal in my opinion as well as the remaining Medical Assistants within our office. After acceptance into clinical for nursing school, I resigned from my position. One week later, I came to the office to collect my things and was met by the DEA!!! After a 1 year investigation, The physician, a nurse practitioner, 3 medical assistants, and an LPN were ALL indicted on 88 counts ranging from conspiracy to prescription fraud. Initially the physician blamed his entire staff and claimed he had no knowledge of what was going on in his practice for the last 10 years. Fortunately, the government found this information to be false HOWEVER, wanted to hold the entire staff accountable for their actions although we only carried out orders or duties that were delegated to us by the physician! There are NO LAWS of DELEGATION in black and white when it comes to the state of Louisiana and the MEDICAL PRACTICE ACT.....TRUST me...I found this out the hard way!!! Medical Assistants work under the DIRECT supervision of a physician and now, I see why! Prior to the indictment I was completing 3rd level which included laws of delegation within the Nurse Practice Act.....it is VERY CLEAR what the NURSE must do when delegating a task to Unlicensed assistive personell! Sadly enough, this DID NOT matter! The jury would not have been instructed on laws of delegation....ONLY laws set forth by Louisiana State Board of Pharmacy, DEA, etc. If we had chosen to go to trial, we would have LOST....hands down!!!! We all had to except a plea that would ENSURE we would not spend 10 years in prison away from our children and families!.....REMEMBER....this is the FEDERAL GOVERNMENT!!!!! You can't imagine what this has done to all of the families involved....we were all GOOD people, GREAT medical assistants doing what we were told to do by our physician.
My point is this.......you are an RN!!!!! An RN is held accountable LONG before unlicensed personell!!!!! The fact that you are only doing what you're told to do WILL NEVER hold up when your indicted by the federal government!!! As an RN, you know that if there is EVER a slight feeling that you may suffer consequences of making a decision that may be illegal or unethical......DO NOT do it!!!! You need to get out of there immediately.........It is also your responsibility as an RN to REPORT any facility who may be practicing unethically or illegally otherwise, you may become part of the Conspiracy.......and CONSPIRACY is EXACTLY what this is.......You only have to know about it to be a conspirator!!!!! And trust me, the only person who has YOUR back is YOU....make no mistake about it!!!!!! I've learned quiet a bit about Medical Law through this journey! I hope this information helps as I only wish it were available to me 3 years ago!!!!
And then they sue you for getting them addicted. Your management sucks. Do they even have a medical background? When the go and get their medical license and start seeing patients then they can prescribe non-clinically relevant medications if them want to...maybe they need to be reported!
Sweet Jesus that's scary. No, it isn't legal or ethical. I would stand your ground with the doctors and ask them to put this directive in writing. They will crap out two bricks and know you aren't messing around. They will also never put it in writing because they know it is illegal and unethical. If they want to give meds they know are inappropriate tell them to give it. The docs and nurses shouldn't be putting their licenses at risk.
Our Administration recently reprimanded several ER Doctors and Nurses. The reason- several patients with very very minor problems (ie: Very minor Contusions, Acute Rhinitis, Bumped Acrylic Fingernail, Superficial Paper Cut) had requested "Strong Pain Medicines" (ie: Morphine, Fentanyl, Dilaudid IM/IV and presciptions for Oxycodone, Hydrocodone to go) and didn't get them. While they didn't receive these medications due to the ER doctors didn't feel it was Clinically Indicated, the patients did receive appropriate interventions, such as X-Rays, CT scans, crutches, ice packs, elaborate wound care, Motrin, Tylenol, wheelchair service, etc.
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Medic/Nurse, BSN, RN
880 Posts
Oh yeah - I forgot.
Where are you? - What would these complaints be worth? my back has been hurting lately and I have a toothache, a migraine, a really wicked hangnail, my TMJ has been acting up, my IBS is so painful, my cat bit me and it really hurts, I pulled my neck and now it really hurts and I've got blisters from my high heels shoes and the new tattoo is burning so bad I cannot stand the pain. Oh yeah - it really hurts when I pee.
Oh yeah - I'm allergic to tylenol, motrin, toradol, morphine, compazine, steriods and benadryl.
The only thing that helps is - dilaudid, phenergan and oxycontin.
And I know my way to managements office and I have rights!
I :heartbeat your ER!!!