tag:blogger.com,1999:blog-4968787219619380438.post6447810062402979692..comments2023-09-21T04:02:29.457-04:00Comments on Skeptical Scalpel: The opioid epidemic: What was the Joint Commission's role?Skeptical Scalpelhttp://www.blogger.com/profile/13206922456661320751noreply@blogger.comBlogger13125tag:blogger.com,1999:blog-4968787219619380438.post-81892182306518097722017-07-17T06:50:12.556-04:002017-07-17T06:50:12.556-04:00Autumn, good story. It's a nice illustration o...Autumn, good story. It's a nice illustration of how regulating every bit of minutia doesn't work.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-66165566259900483092017-07-13T22:57:05.854-04:002017-07-13T22:57:05.854-04:00Another small rural hospital was told that all pai...Another small rural hospital was told that all pain med orders had to be written with pain scale ratings included, eg plain tylenol for pain up to a 4, a tylenol/narcotic combo for a pain of 5-7 and a parenteral narcotic for pain above an 8. Therefore if you(the RN) needed to deviate from this you had to call the physician. Ok, I see this to a point, didn't like it much, but the day my 80 something patient told me her pain was a 7 but she didn't want Percoset because she was going to PT. I was obliged to call a physician to obtain this one time order for tylenol that was already in her med profile...yup the doc was...rather unhappy. As you can tell I'm still steamed months later. Let me document the pain level as the patient states it, along with the patients request for tylenol instead, don't make me destroy any limited value of using a pain scale by teaching said patient how to give the right number for the desired medication. "The Joint Commission" belongs in the joint for the mess they've made! Autumnhttps://www.blogger.com/profile/04718546581547191102noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-85357604560757345852017-06-04T13:04:32.354-04:002017-06-04T13:04:32.354-04:00Todd, thanks for your comments. You story about th...Todd, thanks for your comments. You story about the patient with the "pain emergency" is LOL funny.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-6872419099330487012017-06-04T10:17:49.058-04:002017-06-04T10:17:49.058-04:00You should see the NCCN guidelines for pain. On a ...You should see the NCCN guidelines for pain. On a 1-10 scale, they call 7-10 "severe" pain. NCCN recommends admission in some cases if the patient has a 7-10 pain level. Of course you would be surprised how many patients smile and seem quite fine at self-reported pain levels of 7-10. One attending I had told the story of the patient who had a pain level of 10 and was recommended to come in to the hospital by a fellow as a "pain emergency." "Doc, maybe we can reschedule the emergency to day after tomorrow because I need to work today and tomorrow and have lots to do at home."Todd J. Scarbrough, M.D.https://www.blogger.com/profile/09254631173069503684noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-68156270959723618762017-06-03T12:33:27.506-04:002017-06-03T12:33:27.506-04:00Thanks for all the comments. That's a good poi...Thanks for all the comments. That's a good point about the name change by the AORN.<br /><br />I too found most patients are not reluctant to speak up when they have pain. One could infer that if you have to ask the patient about his pain, maybe it is not that bad.Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-20140999904138028922017-06-02T22:45:28.335-04:002017-06-02T22:45:28.335-04:00OldFoolRN, you should change your username to OldW...OldFoolRN, you should change your username to OldWiseRN. artigerhttps://www.blogger.com/profile/13361655152970244221noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-25483455864959292562017-06-02T21:17:30.232-04:002017-06-02T21:17:30.232-04:00Never trust an entity that keeps changing it's...Never trust an entity that keeps changing it's name. JCAHO was something I had never heard of until I deduced that it was the bastard spawn of JCAH. Decades ago a JCAH inspector shut down our entire OR suite claiming that out knee actuated valves on our scrub sink needed to be converted to foot pedals.<br /><br />AORN was always known to me as Association of Operating Room Nurses. I think they also changed their name to exclude LPNs. If they are preoccupied with membership criteria maybe they will lay off on such foolishness as surgical cap requirementsOldfoolrnhttps://www.blogger.com/profile/01747485143127099085noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-13859334357226949102017-06-02T20:28:31.527-04:002017-06-02T20:28:31.527-04:00I live & work in a rural SD hospital that part...I live & work in a rural SD hospital that participates in Medicare. Like a previous commenter, we are also not JCAHO certified, but we are surveyed by CMS.Pamhttps://www.blogger.com/profile/13537766712596016192noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-13919691452026490222017-06-02T16:23:57.129-04:002017-06-02T16:23:57.129-04:00Maybe now my PACU nurses will stop waking my immed...Maybe now my PACU nurses will stop waking my immediately postop patients to ask if they are having pain? Cuz, y'know, you can't trust the patients to tell you....Dr. Souphttps://www.blogger.com/profile/05534045848537420006noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-31433540745496958322017-06-01T18:24:51.828-04:002017-06-01T18:24:51.828-04:00Scalpel, we are state accredited. I have found it...Scalpel, we are state accredited. I have found it to be much less onerous (read: reasonable) than JC. artigerhttps://www.blogger.com/profile/13361655152970244221noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-11662750879440279972017-06-01T13:43:47.391-04:002017-06-01T13:43:47.391-04:00In a just world, the Joint Commission and Russell ...In a just world, the Joint Commission and Russell Portenoy, the Purdue Pharma paid shill, would be hung upside down and beaten with sticks for creating a nation of addicts.orthodochttps://www.blogger.com/profile/07690691443842295090noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-47374976085138398162017-06-01T13:22:32.657-04:002017-06-01T13:22:32.657-04:00I thought the rules say a hospital must be JC accr...I thought the rules say a hospital must be JC accredited or state accredited to participate in Medicare.<br /><br />"For any organization to receive funding from Centers for Medicare and Medicaid Services (CMS), that organization must meet either the "Conditions for Coverage" or the "Conditions of Participation". These are a set of minimal standards which must be met before CMS will ever issue any reimbursement for Medicare and Medicaid Services. Two kinds of organizations can review a health care provider to check for compliance with these conditions - either a state level agency acting on behalf of CMS, or a national accreditation agency like the Joint Commission."Skeptical Scalpelhttps://www.blogger.com/profile/13206922456661320751noreply@blogger.comtag:blogger.com,1999:blog-4968787219619380438.post-8598231907475580872017-06-01T12:44:41.023-04:002017-06-01T12:44:41.023-04:00We'll get a Joint Commission apology right aft...We'll get a Joint Commission apology right after AORN publicly admits it erred about the surgical cap nonsense. <br /><br />When people ask how I can stand working in a very small rural hospital, one of the reasons I give...no Joint Commission crap. We take care of patients quite well without them. artigerhttps://www.blogger.com/profile/13361655152970244221noreply@blogger.com