Hospital Emergency Department Policies

 

The emergency department (ED) is a source of many prescriptions for opioid pain medications. There are several factors that could increase the risk of adverse events in patients receiving controlled substances through the ED. Since there is no ongoing physician-to-patient relationship in most cases, the ED provider may not have readily available information regarding co-morbid medical conditions, other prescription medicines the patient is taking and possible drug-to-drug adverse interactions, or other patient factors that could increase the risk for overdose. There are also patients who exhibit “drug seeking behavior” and come through the ED, sometimes even multiple EDs, to get controlled medications for a variety of reasons, including trying to address unrelieved pain and issues related to medication dependency. For these reasons, it is recommended that hospital EDs develop a system-wide standard protocol with respect to prescribing narcotic analgesics. Considerations in developing an opioid prescribing policy might include the following points:

 

• ED will avoid prescribing controlled substances for pain that is chronic and, instead, prescribe a non-narcotic medication and refer to the patient’s primary care provider, pain specialist, or dentist.

• ED will avoid providing refills for chronic pain medications due to lost prescriptions, need for after hours, or weekend refills.

• ED provider should check the PDMP (CSRS) before prescribing a controlled medication for pain.

• ED will limit the number of doses of controlled medications dispensed or prescribed. For instance, the default number for computerized prescriptions for opiates will be set at #10 or less for chronic pain.

• For patients who are frequently seen in the ED for pain complaints and who have no established primary care provider, the ED or other hospital staff will work to help get that patient established with a regular provider.

• ED will create a case manager position to work specifically with patients dealing with chronic pain and substance abuse issues, as well as coordinate appropriate care and work with patients who are under-or uninsured.