By Randal L. Dabbs, MD, FACEP, FAAFP, TeamHealth Co-Founder, President, Practice Development, and Executive Sponsor, TeamHealth Substance Use Work Group
Oh no! I gave too many, or too strong, or too soon, or for too long! But the patient is still in pain; can’t tolerate NSAIDS; toradol doesn’t help. I feel guilty that I only prescribe a Tylenol #3 for a shoulder dislocation, but I don’t want to cause an addiction. What am I supposed to do?
Whether you lean toward the side of the “candy man” or the side of “suffering builds character,” you have likely questioned your opioid prescribing practices. However, questioning is good – it’s a start – it means you understand the issue and are searching for the sweet spot.
My initial interest in managing pain in the emergency department came from a clinician wellness perspective. After multiple confrontations with “narcotic seeking pain patients,” I realized my daily gasoline allowance was on reserve way too early in my shift, which prevented me from giving much needed empathy to my next 20 patients. So I created a strategy to never argue with the difficult patient seeking the medicine that started with a “perc” or a “D,” and to refuse to get angry or judgmental. Three decades later, I now realize it’s not just my well-being I should be concerned about – it’s also about making the right decision to prevent my next patients from becoming the “narcotic seeking pain patient” that I used to dread. Now I must recognize the potential addict as well as offer advice to get help to the patient who is already addicted if they are open to it.
The way I see it, there are two types of pain patients – those that already have an addiction and those you are trying to prevent from becoming addicted. Struggling with the right choice of pain medication is a good thing – it means you recognize both the benefit of adequate pain treatment and also the dangers inherent in prescribing a narcotic. Optimizing Opioid Prescribing Strategies (OOPS) means you don’t want to make a mistake. It means every patient with pain deserves your consideration for optimizing their medication in order to hit the sweet spot. And when you hit the sweet spot – “not too much and not too little,” your self-wellness will follow because you know you’ve done what is best for the patient.
Beyond Clinical Medicine Episode 25: Opioid Light Initiative Two Years Later
Marilyn McLeod, MD, System Medical Director, Baptist Memorial Health in Memphis, Tennessee, and a fellow member of the Substance Use Work Group, has seen first-hand the need for strategy related to opioid prescribing in the emergency department.
Listen to this episode of Beyond Clinical Medicine to learn how they used data to optimize opioid prescribing while improving patient safety and patient satisfaction scores.