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The Water Cooler
General Discussion
Opioid Crisis in OK; Who’s to Blame?
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<blockquote data-quote="C_Hallbert" data-source="post: 3249522" data-attributes="member: 42957"><p>I worked in Healthcare for nearly 39 years as a Registered Respiratory Therapist with the last 24 years as a Director of Respiratory Care Services. All of my time was spent in Acute Care Hospital settings. My duties ranged from clinical care to management with added assignments outside of my immediate area of responsibility like Medical Waste and HAZMAT Coordinator; Paperless Charting Development; Safety, Medical and Pharmacy Committees. </p><p></p><p>From 1981 to 2009, I was responsible for insuring that my service areas were compliant with standards of care, state and federal regulations, legal requirements, and quality of care standards as described by the JCAHO and HCFA (now CMS). </p><p></p><p>As I recall, in the late 1980s or early 1990s, JCAHO and HCFA jointly developed Quality of Care Goals and Quality Improvement Goals (later years adding Patient Safety Goals) with which Hospitals and Clinics were required to document their compliance and track their performance. </p><p></p><p>Well, I think around 1994-5 these agencies came up with a Pain Management Patient Care Goal. To achieve compliance with this goal, criteria were established that set standards that all medical records reviewed were expected to demonstrate. Patients were issued a Patient Bill of Rights on admission where they were informed ‘they had the right to be pain free’. </p><p></p><p>Physician Documentation of Pain Assessment was required in Medical Records in the ‘History & Physicaal’, ‘Initial Assessment’, ‘Patient Care Plan’, ‘Progress Notes’ and ‘Discharge Summary’.</p><p></p><p>Nurses were required to independently document Pain Assessment in their ‘Initial Assessment’, ‘Nursing Care Plan’, ‘Nurses Notes’-and ‘Discharge Notes’. Ancillary Services providing direct patient care had virtually the same charting requirements as Nursing. </p><p></p><p>JACHO and HCFA (CMS) inspect and grade Hospitals and Clinics for compliance with numerous standards. They can be ruthless on facilities that don’t measure up to their standards. Accreditation is awarded for passing institutions. It is important because Medicare/Medicaid Reimbursements are denied for facilities that fail Accreditation. </p><p></p><p>Patient Surveys to insure Patient Satisfaction were implemented. Pain Control was assessed from the patient’s perspective. Data from these documents was fed back to evaluate Physician/Nursing/Other Practitioners Performance. This feedback mechanism coupled with the emphasis on documenting Pain Assessments and Interventions drove Physicians to increase the use of narcotics and opioids because patient dissatisfaction with pain levels negatively impacted their performance evaluations and careers. </p><p></p><p>I went through this whole conundrum because before the beginning and of the Opioid Epidemic it was the idea of the government’s HCFA/CMS and the JCAHO to use patient perceptions of pain control as an Accreditation Standard that caused the increased prescription rate for narcotics and opioids by Physicians. And he crux of this is.....patients reporting of their pain levels are unreliable! I’ve seen patients that are laughing and moving around freely report Pain Levels of (10) on a (1-10) Scale. </p><p></p><p></p><p>Sent from my iPhone using Tapatalk</p></blockquote><p></p>
[QUOTE="C_Hallbert, post: 3249522, member: 42957"] I worked in Healthcare for nearly 39 years as a Registered Respiratory Therapist with the last 24 years as a Director of Respiratory Care Services. All of my time was spent in Acute Care Hospital settings. My duties ranged from clinical care to management with added assignments outside of my immediate area of responsibility like Medical Waste and HAZMAT Coordinator; Paperless Charting Development; Safety, Medical and Pharmacy Committees. From 1981 to 2009, I was responsible for insuring that my service areas were compliant with standards of care, state and federal regulations, legal requirements, and quality of care standards as described by the JCAHO and HCFA (now CMS). As I recall, in the late 1980s or early 1990s, JCAHO and HCFA jointly developed Quality of Care Goals and Quality Improvement Goals (later years adding Patient Safety Goals) with which Hospitals and Clinics were required to document their compliance and track their performance. Well, I think around 1994-5 these agencies came up with a Pain Management Patient Care Goal. To achieve compliance with this goal, criteria were established that set standards that all medical records reviewed were expected to demonstrate. Patients were issued a Patient Bill of Rights on admission where they were informed ‘they had the right to be pain free’. Physician Documentation of Pain Assessment was required in Medical Records in the ‘History & Physicaal’, ‘Initial Assessment’, ‘Patient Care Plan’, ‘Progress Notes’ and ‘Discharge Summary’. Nurses were required to independently document Pain Assessment in their ‘Initial Assessment’, ‘Nursing Care Plan’, ‘Nurses Notes’-and ‘Discharge Notes’. Ancillary Services providing direct patient care had virtually the same charting requirements as Nursing. JACHO and HCFA (CMS) inspect and grade Hospitals and Clinics for compliance with numerous standards. They can be ruthless on facilities that don’t measure up to their standards. Accreditation is awarded for passing institutions. It is important because Medicare/Medicaid Reimbursements are denied for facilities that fail Accreditation. Patient Surveys to insure Patient Satisfaction were implemented. Pain Control was assessed from the patient’s perspective. Data from these documents was fed back to evaluate Physician/Nursing/Other Practitioners Performance. This feedback mechanism coupled with the emphasis on documenting Pain Assessments and Interventions drove Physicians to increase the use of narcotics and opioids because patient dissatisfaction with pain levels negatively impacted their performance evaluations and careers. I went through this whole conundrum because before the beginning and of the Opioid Epidemic it was the idea of the government’s HCFA/CMS and the JCAHO to use patient perceptions of pain control as an Accreditation Standard that caused the increased prescription rate for narcotics and opioids by Physicians. And he crux of this is.....patients reporting of their pain levels are unreliable! I’ve seen patients that are laughing and moving around freely report Pain Levels of (10) on a (1-10) Scale. Sent from my iPhone using Tapatalk [/QUOTE]
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