Patients No Longer on Hold for Pain Relief

by Nursing Homes Staff on October 20, 2010

Narcotic pain killers were developed for patients in severe pain and in immediate need of relief, but drug enforcement actions often jeopardize the timely delivery of pain medications to patients in nursing homes.

  • Since narcotics carry a high risk of diversion to unauthorized use, the Drug Enforcement Administration (DEA) began auditing a number of long-term care facilities in 2009 to evaluate their compliance with the rules for prescribing and dispensing controlled substances.
  • Existing DEA rules treat nursing home patients as outpatients, but nursing homes are more like hospitals than doctors’ offices with respect to how they are operated and the amount of oversight where prescription drugs are dispensed. In many cases, patients coming straight from the hospital may develop symptoms after arrival, and doctors cannot always be reached. Once the doctor is located, there are problems in evaluating patients who are no longer on site. This leaves many elderly and frail patients in long-term care centers awaiting pain relief, sometimes for days.
  • According to a survey last March by the Quality Care Coalition for Patients in Pain (QCCPP), 65.4% of physicians, nurse practitioners, pharmacists, nurses and other clinicians across 46 states say that DEA procedures are causing delays in getting pain medication to their patients.
  • The Senate Special Committee on Aging held a hearing on the subject earlier this year, in which advocates testified that the existing drug enforcement rules interfere with the ability of health care workers to provide adequate support for patients in need of controlled medicines in long-term care facilities.
  • The DEA released new rules at the end of March, set to take effect in June, which would give physicians the option of issuing electronic prescriptions for controlled substances, but stopped short of authorizing nursing home employees to dispense medications without a prescription in the event the doctor cannot be reached.
  • In early October, the DEA again updated the guidelines for its enforcement of drug policy. The new rules allow physicians to authorize nurses in long-term care facilities to act as their agents, and allow such agents to phone in prescriptions to pharmacies. Under previous guidelines, nurses and other long-term care employees were granted no such authority.

Nursing homes now have options when doctors cannot be reached and patients are in pain. The new guidelines issued by the DEA should “expedite in many cases getting the prescription processed and dispensed by the pharmacist, delivering it to the ultimate user and decreasing the potential for a patient to be in pain or discomfort longer than necessary,” according to a spokesperson from the American Society of Consultant Pharmacists.

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