Our government continues to make attempts to tell us how and when to practice medicine, so we must be very diligent in following the guidelines that have been established in each state with regards to pain management and the use of narcotics.
Docs Who Care has maintained a strong stance in encouraging us to be careful about the use of narcotics and to be especially careful in the amount we prescribe. However, at the same time, we have the obligation to take care of individual patients in a manner best suited for their needs.
Make certain you are aware of any new regulations or policies that have been developed in the state or states where you work. It may be helpful to understand how the local hospital and pharmacies are looking at the situation.
If you are working in clinics where patients are receiving regular doses of narcotics, make certain they have a contract that clearly spells out the parameters of usage. If a patient is on a contract, provide clear documentation in the chart of a visit with a pain management professional and/or clear documentation of the exact continuing reasons the patient needs the narcotic. It would seem prudent to update the patient’s chart every six to twelve months in this regard.
Carefully document the exact reason you are choosing to use narcotics, even on a short-term basis, in an ER or clinic setting. Don’t assume it is clear from the situation you have documented, and only give refills of narcotics in the ER setting in rare circumstances.
In sites where you work regularly, you will inherit patients who may be on inappropriate doses of narcotics. Without creating real animosity with patients, I would encourage you to show evidence in the charts regarding the pros and cons of their individual situations and encourage them to consider other regimens if appropriate.
Remember, we can be compassionate and caring while still being firm about what should change. Hospital administrators appreciate it when we can do this with tact and finesse.
Paul Wardlaw, MD – Medical Director (CO, NE, KS)
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