One good idea is to beef up prescription drug monitoring programs. In my state there is a data base that providers can access to see exactly how many scripts the patient has got in the last months.
Excuses I have heard doctors say about prescribing narcotics in ER: They just want to get rid of the patient. They don't want a confrontation. They don't want to be complained about. They figure they are only doing it once, no refills. The thing is every doctor thinks that and it goes on and on.
I hate participating in this as a nurse. It doesn't take a rocket scientist to figure out who the drug seekers are, especially the frequent flyers. It turns my stomach to give these people narcs. I honestly don't know how docs live with themselves around this issue. The whole thing is shameful.
When I was a nurse manager, I had a doc come to my office to ask me how to get around the alert in the computer put in by her primary care doctor that a certain patient shouldn't have narcotic prescriptions because she had been caught diverting and doctor-shopping. She was in the ER for...chronic pain. "It's not letting me order a narcotic prescription because it keeps saying she's been caught diverting narcotics and doctor-shopping...how do I get around that?"
ReplyDelete"Maybe you shouldn't be prescribing narcotics to this patient and refer her to her primary?"
"Well, I am giving her the benefit of the doubt. I'm just giving her 20 Percocet afterall."
Whatever. He was the medical director too. If the medical director is doing that stuff, how can you expect support if you deny narcotics to a patient and they bitch and moan?
PS
ReplyDeleteNo, I didn't tell him how to get around the alert.
He wrote her a script by hand instead of using the computer.
Recent story from here up north that I think adds to this discussion. Two men have been arrested after allegedly double dipping scripts from an number of Docs for a total of 67,000 tabs of Oxycontin which they then allegedly sold for (depending on the news source you read) up to 3.4 million dollars.
ReplyDeleteLink to the story I mentioned just in case:
ReplyDeletehttp://www.am770chqr.com/News/Local/Story.aspx?ID=1405556
In my state, the prescription monitoring program SUCKS. I've looked up patients and I can see from the ED records that they had 3 previous visits where they were prescribed narcotics. But yet they don't show up in the database. Or the patient will actually tell me they have a pain contract with a doctor, but yet the prescriptions don't show up in the database. I don't know what the problem with the database is, but it's not useful.
ReplyDeleteThese programs are a good idea, but currently aren't ready for prime time.
I refuse to give the seekers narcs 99% of the time. Too bad everyone in my group does not agree with that.
ReplyDeleteERP- you are my hero. I give props to our docs who are like you. But, sometimes it doesn't last. Like when one of our docs was "talked to" for not giving narcs to a patient who complained. The doc was right and justified. I felt bad for him.
ReplyDeleteClearly drug seekers are not sane if they are seeking drugs , so declare them INSANE then you can force the correct medicines into them, psychiatric medicines.
ReplyDeleteWould you make a prescription necessary for the purchase of alcohol and tobacco as well?
Legalize all drugs , then you will no longer have drug seekers to fend off .
"From Colonial times until 1914, Americans were the authors of their own drug policy: They decided what substances to avoid or use, controlled the drug-using behavior of their children, and assumed responsibility for their personal conduct. Since 1914, the control of, and responsibility for, drug use -- by adults as well as children -- has been gradually transferred from citizens to agents of the state, principally physicians." wrote Thomas Szasz
The solution is not doctor responsibility, it's government involvement. The government can moitor us and make it all right, and the best part is we don't have to do a thing (except pay more taxes to fund the new programs and suffer the consequences of hyper-documentation regulations).
ReplyDelete