- Joined
- Nov 21, 1998
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Situation: 56 year old morbidly obese female with bilateral hip AVN status post bilateral THA with multiple medical comorbidities (RA, COPD, DM, HTN, and Crohn;s disease) admitted to SNF for post-acute care rehabilitation. Post-op course complicated by DVT and difficult to control pain. Acute care hospitalist RX's FNT TD 150 mcg/hr and oxycodone 30 mg Q 4 hrs PRN BTP prior to transfer to SNF. POD #21 patient now ready for DC to apartment with home health.
Background: You receive a call from SNF MSW begging you see patient at SNF for "pain management consult." The request is politely denied. SNF medical director refuses to RX pain meds for discharge. PCP refuses to RX pain meds due to clinic policy abstaining against greater than 90 morphine equivalents for non-malignant pain. Patient refuses discharge without "guaranteed" pain management plan.
Assessment: Opioid Refugee squatting in SNF.
Recommendation: Telemedicine huddle and conference with pain specialist, SNF administrator, SNF medical director, legal counsel, clergy, and ombudsman. Patient offered medical transport to pain clinic contingent upon schedule availability. If refused, then proceed with charges for trespassing and DC to jail with law enforcement chaperone.
Background: You receive a call from SNF MSW begging you see patient at SNF for "pain management consult." The request is politely denied. SNF medical director refuses to RX pain meds for discharge. PCP refuses to RX pain meds due to clinic policy abstaining against greater than 90 morphine equivalents for non-malignant pain. Patient refuses discharge without "guaranteed" pain management plan.
Assessment: Opioid Refugee squatting in SNF.
Recommendation: Telemedicine huddle and conference with pain specialist, SNF administrator, SNF medical director, legal counsel, clergy, and ombudsman. Patient offered medical transport to pain clinic contingent upon schedule availability. If refused, then proceed with charges for trespassing and DC to jail with law enforcement chaperone.