The American Opioid Epidemic 20XX: Dropping the H-Bomb

The Something Awful Forums > Discussion > Debate & Discussion > The American Opioid Epidemic 20XX: Dropping the H-Bomb

blackguy32: Oct 1, 2005; Say, do you know how to do the walk?

I wouldn't doubt that a lot of it is related to how competitive hospitals can be. Where I work, we assess pain once per shift and ask about their pain every hour. Hcaps surveys also ask how well pain is controlled and hospital reimbursement is based on the surveys.

# ¿ Jan 22, 2016 01:11

Adbot: ADBOT LOVES YOU

# ¿ May 2, 2024 09:11

blackguy32: Oct 1, 2005; Say, do you know how to do the walk?

Cantorsdust posted:

This is a big part of it. Running chains of hospitals is now big healthcare business. They meticulously track patient satisfaction scores, pain scores, etc for each doctor. And hospitals themselves are tracked on the same scores by both private sources online and publicly. I know Medicare was considering penalizing you a certain percentage of your reimbursement if your patient satisfaction was too low.

90% of your patients, if asked their satisfaction with their care, would say you're doing a good job, regardless of how well you're doing. They don't know any better. But do you know the number one cause of complaints? Not giving the patient what they want, even if they don't need it, even when it's bad for them.

So when you have 40 patients in your busy ER and you're running from room to room spending 5-10 minutes per patient, and you just need them to go away, are you really going to take the time to sit down and patiently explain to them why you won't be giving them their meds? Or why the patient you're discharging from the hospital can't have "just a little more to cover me until my next refill?" Are you going to risk getting chewed out over easily preventable bad satisfaction scores? No. You'll give the patient what they want. That's, unfortunately, the mindset I see in my collegues. They know there's a problem, but the system actively disincentivizes you to do anything about it.

Yeah, it's awful from a nurses end. Patients want pain meds yet they are falling asleep standing up or they want Phenergan iv, never mind if it will eat up your vein. Meanwhile the hospital keeps riding on you to say stupid poo poo designed to bring scores up such as "for your comfort" etc. It's now resulting in some patients taking advantage

# ¿ Jan 26, 2016 04:06

blackguy32: Oct 1, 2005; Say, do you know how to do the walk?

reagan posted:

I just sat in on a lunch presentation with a Pfizer rep ~~paid physician shill~~ giving a presentation on ~~selling~~ some lovely drug. Expect many more novel drug designs like this in a pathetic attempt to dissuade people getting high as gently caress.

But hey, free lunch.

I don't see anything wrong with that? It's pain medicine with a antagonist that doesn't really affect the pain part of the medication which gets helps with the itching and constipation that usually goes with these medications.

We give realistor in the hospital for opiod related constipation.

# ¿ Mar 19, 2016 04:22

blackguy32: Oct 1, 2005; Say, do you know how to do the walk?

deathbysnusnu posted:

The difficulty is the frequent back and forth. If it's someone with say a fracture then they get the good stuff, and generally a lot more than what I would give a non addicted person (tolerance) and I'm ok with that. If it's someone with say a pneumonia, it will start with nursing paging me that they want something with pain. I'll order Tylenol. I get paged back later, the Tylenol isn't working, i'll give some naproxen. Page back that's not working. I explain no opioids. I get called in. Lots of anger directed at me, still no opioids. Often there's threats that they'll leave the hospital against medical advice unless they get the pain meds they want.

Or you get people who really love to game the system. They'll come in with idiopathic pain that has nothing on labs or exam or imaging that can prove or disprove it. They'll know magic words for admission like vomiting blood or can't eat or drink at all. Then comes the strategic allergies. It's always toradol, tramadol, zofran, codeine, and morphine. Leaving dilaudid and phenergan for nausea and pain. It's super hard not to project onto people when you know they're gaming you, and when you try and directly but politely address the issue there's an 80ish percent chance they'll rain a stream of drama down on you while you have 10 other patients you could be seeing instead.

I can attest to this from the nursing side. For some people, nothing is good enough unless it's IV and it has to be very specific. Dilaudid, phenergan, and benadryl iv. Never mind that phenergan iv is caustic poo poo that will tear up your tissue. But to add to that, usually if you are taking that much stuff, you will eventually run into complications which lengthens your stay and the longer you stay in the hospital, the longer your recovery tends to be.

Add to that that many know that hospitals are trying to hunt down those high hcahps scores, them you have hospitals influencing the staff to do whatever it takes to get the patient what they want. There is a whole system based on kind of influencing patients to giving high scores. "We always will hourly round." We say my pleasure instead of you're welcome. I think some patients have picked up on that and some are gaming that. We are in the world where hospitals have patient liasons for the sole reason of increasing hcahps scores which those surveys by their nature are designed to reimburse as little as possible.

# ¿ Apr 7, 2016 23:39

blackguy32: Oct 1, 2005; Say, do you know how to do the walk?

Sickle cell is one of the biggest reasons people come in for pain on my floor and since it's primarily an African disease, you know how that turns out. But yeah, many people's expectations of pain relief is unrealistic. And it gets to be a problem when it comes to weaning them off to oral medications because many just straight up refuse to take them and of course in the name of customer satisfaction, hospitals are willing to oblige them and give the pt what they want.

But the research shows that hospitals with the highest pt satisfaction score have some of the worst pt outcomes.

# ¿ Apr 8, 2016 08:12

blackguy32: Oct 1, 2005; Say, do you know how to do the walk?

moller posted:

See also adding acetaminophen to codeine and similar. You can "discourage abuse" by killing the poo poo out of people.

Well sort of. There is evidence out there that adding acetaminophen to opiates increases the analgesic efficacy. We often give iv Tylenol to post op patients on pca pumps for this very reason.

# ¿ Apr 26, 2016 05:29

blackguy32: Oct 1, 2005; Say, do you know how to do the walk?

I know quite a few people are pissed that the CDC recommended that opioids not be prescribed for chronic pain. I know I feel kind of bad for doctors who must feel like they are trapped between a rock and a hard place.

# ¿ Oct 19, 2016 18:51

Adbot: ADBOT LOVES YOU

# ¿ May 2, 2024 09:11

blackguy32: Oct 1, 2005; Say, do you know how to do the walk?

Cockmaster posted:

I could've sworn I had heard that recent research points to opiates being not that great for long-term pain management.

They aren't. But good luck getting people to believe that. I have had people half asleep demand for their pain medicine because it's due, but then when I go to their room to administer it, they are stone cold knocked out. Many people really are poor judges of what they can take when it comes to pain. Many of them are very unrealistic when it comes to managing their pain.

# ¿ Jan 22, 2017 00:18

The Something Awful Forums > Discussion > Debate & Discussion > The American Opioid Epidemic 20XX: Dropping the H-Bomb