No pain meds in ER??

ShaneTeam · Apr 3, 2016

ED patients don't get surveyed

Actually, we have to give them a survey with their discharge instructions, since they were not going back to the registrar to set up payments after treatment.

Anna Flaxis, BSN, RN · Apr 3, 2016

ED patients don't get surveyed

Yes, they absolutely do, and whether their pain was adequately controlled is one of the survey questions.

Germanicus3767 · Apr 3, 2016

I was working in urgent care and my clinic had a number of drug seekers coming in with bogus complaints. Bumping up hydrocodone to a schedule II drug eliminated a lot of them since the clinic was staffed by NPs and we couldn't prescribe over schedule III. The most valuable tool I found was the Georgia Prescription Drug Monitoring Program website. When I logged on to it I could see every prescription for opioids the patient had received and also when and where they got them. In cases where the patient was getting drugs from multiple sources I would print out the patient's opioid history and confront them with it then kick them out without prescribing any more opioids. I don't know how many other states have this program but it sure is helpful in weeding out drug abusers.

Altra, BSN, RN · Apr 4, 2016

Most of this entire thread is extremely disappointing. Hearsay ... hyperbole ... and very incomplete understanding.

No one is "outlawing" anything. No meds are being "pulled" from St. Joseph's (the hospital in question) or any other ER. This is not an ER in which there are "no pain meds", as suggested by the thread title.

As crisis rages, hospital works to reduce opioids in the ER

St. Joseph's ER (one of the busiest ERs in the country) is rethinking its pain management protocols, with the goal of reducing opiate use. This is specifically for ER care, for patients who do not already have a condition requiring opiate pain management.

And to the poster who commented that ER patients are not surveyed -- that is not an accurate statement.

1056chris · Apr 4, 2016

I think it is ridiculous and cruel. Yes there are drug seeking individuals. But as professionals, I think we can weed MOST of these out. I would rather give one drug seeker a Vicoden or pain shot then let others suffer. ER stands for Emergency Room, and I realize not all individuals use it this way, but I believe most do. Chest pain, broken bones, pancreatitis, chronic migranes, lupus, cancer, sickle cell anemia, dislocations, and acute flare ups of multiple conditions and falls leave many people suffering. Sometimes these things need tests that take time. If these people suffer because we are afraid of drug seekers who suffers? The people that are truly in pain. I don't work the ER, I assess, I ask, and observe. I will not judge unless the behavior is observed and or documented. If by chance a drug seeking individual gets something they will also suffer in the long run, because there will be a record and if they don't get caught then they will suffer addiction.

NutmeggeRN, BSN · Apr 8, 2016

I've had patients tell me the iv acetaminophen worked better then the other iv pain meds they were getting. Yet we hardly ever use it. Go figure.

A friend had a TKR done and they used a catheter in her knee for continuous infusion of acetaminophen, she was able to bend her knee almost completely in a few days! She took very few pain meds and was walking very well!!!

ShaneTeam · Apr 10, 2016

I really wish that they would come down on the price, though.

heron, ASN, RN · Apr 10, 2016

IV acetaminophen is used in the UK - is it equally expensive there, I wonder?

ShaneTeam · Apr 10, 2016

Don't know. But wouldn't you know it? The pharmaceutical companies find something that works, and they want an arm and a leg for it.

chrabi417 · Apr 11, 2016

Ofirmev is great stuff!! I saw it used a lot for fresh post-op patients and even some in the ICU.

One patient described the medication as "magical".

But I learned the hard way not to walk into a patient's room and announce that you are about to give them "IV Tylenol".

I was promptly told by one patient that Tylenol wasn't going to cut it and then told where I could shove that "Tylenol".

No amount of education in the world could fix the fact that in this patient's mind I thought so little of her pain that I would have the nerve to offer her just some Tylenol. :no:

chrabi417 · Apr 11, 2016

... I've also seen post-op open heart patients literally levitating off the bed in pain after giving them IV Tylenol because it didn't touch their pain.

Wait! Are you saying the post-op open heart patients were only getting Ofirmev?!

Yikes!!

I've only ever seen it used as an adjunct, usually in addition to a dilaudid or morphine PCA pump.

ShaneTeam · Apr 11, 2016

Ofirmev is great stuff!! I saw it used a lot for fresh post-op patients and even some in the ICU.
One patient described the medication as "magical".
But I learned the hard way not to walk into a patient's room and announce that you are about to give them "IV Tylenol".
I was promptly told by one patient that Tylenol wasn't going to cut it and then told where I could shove that "Tylenol".
No amount of education in the world could fix the fact that in this patient's mind I thought so little of her pain that I would have the nerve to offer her just some Tylenol.

Yeah. We have had to do the same with IM Toradol. Some patients get hung up on a name.