Friday, July 26, 2013 —
TROY – Hospital emergency departments are on the front lines of a national crisis involving the misuse and abuse of prescription medications. The emergency departments at the three FirstHealth of the Carolinas hospitals are no exception.
With the recent adoption of a new policy on emergency department administration of narcotic and sedative medications, however, FirstHealth has taken an important local step toward combating a problem with staggering social and economic implications accompanied by an alarming toll in human lives.
The policy affects the emergency departments at Montgomery Memorial Hospital in Troy, Moore Regional Hospital in Pinehurst and Richmond Memorial Hospital in Rockingham.
It will also affect the emergency department at a new FirstHealth hospital that is scheduled to open in Hoke County this fall.
The new policy was rolled out to the Montgomery County law enforcement and medical communities during a July 18 meeting at Montgomery Memorial Hospital. Speakers included Chrystal Eller, M.D., of the FirstHealth Family Care Center-Troy and president of the Montgomery Memorial Hospital medical staff; and Daniel Barnes, D.O., president of the FirstHealth Physician Group.
Dr. Eller called the problem a community problem that can only be addressed by a community effort.
“Narcotics abuse is more than just an emergency department issue,” she said.
“It is a problem for all providers, and we all need to be part of the solution. This policy will hopefully be our first step in opening a dialogue with patients, providing better education about appropriate management of chronic pain, and reducing the amount of prescription drug abuse and misuse in our community.”
Also attending the rollout program was Montgomery County Sheriff Dempsey Owens, who noted that his office collected, inventoried and transported to the Greensboro office of the North Carolina SBI more than 10,000 pills during a recent weeklong medicine drop program.
“This is a big thing,” he said.
“It’s turned into a bigger drug problem than heroin, crack, PCP and cocaine.”
Sheriff Owens complimented the FirstHealth policy as an important first step, but noted that more needs to be done to educate the community. Prescription medications, he pointed out, often wind up in the hands of people other than those for whom the prescription was written and who may “never get to a doctor until they overdose.”
“I think the education process is what we need,” he said.
“We want to do everything we can to save our people.”
The new FirstHealth policy establishes guidelines (protocols) to be followed by emergency department personnel when a presenting patient claims to be in acute pain but is found after a thorough medical evaluation not to have an emergency medical condition. According to the policy, these patients will no longer be treated with Drug Enforcement Agency-controlled Schedule II, III or IV substances such as Percocet, OxyContin and Vicodin.
Patients who frequently visit emergency departments seeking pain relief will be designated as having a “chronic pain syndrome” and so categorized if they have visited an emergency department for a pain condition more than twice in a 30-day period or more than six times in a year.
A search of the North Carolina Controlled Substance Reporting System (NCCSRS) that indicates a patient is a frequent user of narcotics will result in the same designation. (A Web-based prescription monitoring system, the NCCSRS allows registered dispensers to review a patient’s controlled substances prescription history. North Carolina-dispensed prescriptions for controlled substances are reported to an NCCSRS database, which is updated weekly.)
Emergency department patients who are designated as having chronic pain will be encouraged to follow up with their primary care provider (if they have one) or given a list of area physicians or clinics that are accepting new patients (if they don’t).
Some patients may also be referred to other services, such as pain management, acupuncture, chiropractic or physical therapy, and will be given information on FirstNavistar, FirstHealth’s online database and call center for health care and community-based resources in the Sandhills.
Dr. Barnes told those attending the Montgomery rollout session that the FirstHealth emergency department policy does not affect the “legitimate acute pain” of injury, trauma and terminal illness.
“We want to treat people’s pain,” he said.
At the same time, he pointed out, individuals with “vague complaints” who frequently seek pain medications from a FirstHealth emergency department will be prescribed non-narcotic medications or referred for alternative treatments.
Cheryl Batchelor, R.N., director of FirstHealth’s Care Transition Clinic, facilitated the multidisciplinary Narcotics Prescribing in the ED Task Force that included representation from the following FirstHealth services: all three hospital emergency departments, Behavioral Services, pain management, primary care, and the hospitalist program, pharmacy, corporate attorney and Patient & Family Advisory Council.
Local primary care providers and law enforcement and the Sandhills Community Care Network were also represented.
Scott G. Kirby, M.D., of the North Carolina Medical Board, a recognized expert on the responsible prescription of controlled substances, attended a meeting to share information on improper prescribing as well as on appropriate care for pain patients.
An inspiration for the initiative was Project Lazarus, a nonprofit drug overdose prevention program that encourages community response to pain management. The aim of the statewide program is to address the challenges of prescription medication abuse through a partnership involving Community Care of North Carolina, the North Carolina Hospital Association, local hospitals and emergency departments, primary care doctors, faith-based programs and law enforcement.
Although ultimately approved by FirstHealth’s administration and full medical staff, the Moore Regional Hospital Board of Trustees and the FirstHealth Board of Directors, the task force was “physician-led, because the essence of the problem is in the hands of providers with prescription authority,” Batchelor said.
“Being made aware of the extent of the problem was the driver for us.”