Earlier this week I had a patient that apparently comes into the ED frequently always with abd pain, they can never find anything wrong with him. He must have thought I was an easy target because I have never seen him before. (I only started on the unit in August) Chief complaint? Constipation x 2 days. Takes multiple narcotics, hx of abuse, ect. He is complaining that he has 10/10 pain, as he is sitting up calmly, and is asking for pain meds. I went to the doc and was like, this guy claims 10/10 pain, but look at him. So he goes and does the abd exam with no tenderness on palpation. I had 9 patients that night (some of them really sick) and his wife was harrassing me every minute for something, I was like (in front of the patient too) I have a lot of patients, many sicker than him, that I need to attend to right now, I cant get a pill/give him dilaudid/get him another blanket. The nice lady in bed 2 is about to be intubated and she needs my attention right now. Give me a minute please. He starts saying to me that he is very sick and dying and that I need to focus my attention to him mainly. Than he tells me that I need to order Klonopin for him NOW because he takes it at home and he missed his dose and if he doesnt take now it its "very dangerous". (The doc was getting the d/c papers as we were speaking). He than becomes mad when he finds out he was being d/c'd, he "demanded" to be admitted. Sorry, but a clear CT and x-ray is not going to buy you a day or two free drug stay!
Thank you all for listening to my vent!! I love this site, I can vent about this and you all have been there done that and understand!
Our ER has a policy that anyone who has more than a certain amount of ER visits for any reason in a certain period automatically get a care plan. They (and their primary provider if they have one) are informed that the care plan will be implemented and they are invited to participate in writing their care plan. The care planned patients generally are treated, given enough meds to get them through until the regular clinics are open, and have a definite plan of care for chronic or frequent ailments. We've only had the care plan policy in place for a few months, but we've seen a decrease in visits by our frequent flyers.
Our ER has a policy that anyone who has more than a certain amount of ER visits for any reason in a certain period automatically get a care plan. They (and their primary provider if they have one) are informed that the care plan will be implemented and they are invited to participate in writing their care plan. The care planned patients generally are treated, given enough meds to get them through until the regular clinics are open, and have a definite plan of care for chronic or frequent ailments. We've only had the care plan policy in place for a few months, but we've seen a decrease in visits by our frequent flyers.
The concept of a care plan sounds interesting.... at my hospital, I have seen a core group of pts with ER visits 3-4 times weekly over YEARS never seem to have the real issues addressed. Each visit is approached like it's the first in a way (ie: 10 abd CT scans in a year) but never a conclusion or a plan of care. If it boils down to "pain management" wouldnt that seem to imply a plan also- for example a narcotic contract and set office visits in order to receive pain meds? Thats just me though, I feel that hundreds of "learned physicians" and highly qualified nurses should be able to eventually identify the key problem(s) and agree on a course of action with the person seeking treatment. We even have a sliding scale clinic to which anyone can be assigned a PCP- why dont we enforce it?? Whatta can of worms.
Our ER has a policy that anyone who has more than a certain amount of ER visits for any reason in a certain period automatically get a care plan. They (and their primary provider if they have one) are informed that the care plan will be implemented and they are invited to participate in writing their care plan. The care planned patients generally are treated, given enough meds to get them through until the regular clinics are open, and have a definite plan of care for chronic or frequent ailments. We've only had the care plan policy in place for a few months, but we've seen a decrease in visits by our frequent flyers.
we are working on this at our hospital as well...
but we are running into snags (go figure!)...
what about those who have no primary (do ANY have one!)?
RNin92
444 Posts
No problem my friend!!
And let me just say one more thing...try margaritas!
They are my "drug" of choice!
Hmmmmm...you know what that makes me!!!
Hee Hee Hee Hee
:rotfl: