Please Help!!! New NP Dilemma

[ColumbiaNP]

Hi All,

I am a new Nurse Practitioner working in an outpatient surgical department. This department has 3 well experienced surgeons, 1 chief PA and 2 Nurse Practitioners. This practice, the surgeons are old timers and having major challenges with online prescription as their Electronic Medical Record is a nightmare to navigate. All 3 surgeons still writing prescriptions routinely. On a daily basis, they will write controlled drug prescriptions to give to the patient and many times the patients request to send their medicine order to their pharmacy online so that that they can pick up the medicine on the way home. This falls on me. Other times patients will call the practice to request controlled drugs for pain management. At this time, the surgeons will write prescription and fax to the pharmacy which thy will reject the order.

This is a real dilemma for me as a new NP working in this practice, as I am forced to prescribe controlled drugs for the entire practice because no one else can order this online. I have never seen the patient and no where in the chart what pain medication the surgeon previously ordered. The surgeons will not write why the patient needed the controlled drug, what other options they have tried, how long are they planning to give etc. I am not talking about few weeks post operative pain control. Patients are taking it for years.

What should I do in this situation? Any suggestion??

Thank you All

[NYNPMAN]

I work in a different setting(primary care) but I give a limited course of pain medicine and then refer them to Pain Management. This pain management topic is becoming a snowball rolling downhill and gaining momentum.

[ColumbiaNP]

NYNPMAN,

Thank you for your input. Do we need to give referral from our office for pain management? I need to do something to cut down this narcotic prescription

[djmatte, ADN, MSN, RN, NP]

What you needed first and foremost is an office policy and operating structures regarding pain medication administration. First and foremost, having an honest discussion about expectations pre procedure should occur with every patient. It's appropriate for fresh post op patients to have some form of pain protocol be it with opiates or alternate therapies like gabapentin and or nsaids. But there should be clear understanding on where your care terminates and either the primary care provider takes over or long term management is established. Pain management at your level shouldn't happen. The pcp should be initializing it. Unless you are pushing for a comprehensive rehab strategy where pain symptoms are treated with an array of therapies are utilized which aren't simply opiates.

[ColumbiaNP]

Djmatte,

Thank you for your response. Along with the surgical patients, we have a wound center with over 80% venous ulcer patients. That is the biggest challenge