Saving the world from unnecessary prescriptions

Today I experienced another example of the growing efficiency of the healthcare world: The Steward of Scripts.

First, a little background information is necessary. After I perform surgery it is necessary to perform a number of immediate post operative duties. The operative note must be dictated, a brief note is written in the chart, post operative orders are written and, for patients that are going home the same day, prescriptions must be written. Such prescriptions almost always include pain medication, along with any other medications the patient may need for proper post surgical convalescence.

Typically, the surgeon will sit in the Post Anesthesia Care Unit (PACU), formerly known as the Recovery Room, and do the necessary paperwork and dictation. Years ago blank prescriptions would be readily available in an envelope in the area where we surgeons would sit to chart. A few years ago, an unknown entity in the hospital review stratosphere, most likely someone at an accreditation agency or state health department decided that prescriptions should not be left in the open to be seen or available to just anyone. A directive came from somewhere on high decreeing that prescriptions should be put away, out of sight, so that common lay people would not be tempted to take one and forge a prescription for themselves or someone else. I don’t think it was ever proven that such a problem truly existed, but it seemed like a good idea to a bureaucrat somewhere in the vast hierarchy of healthcare administration gods.

Prescriptions, therefore, were put away, usually in a cabinet, out of sight, but sometimes locked up with the narcotic medications. Thus, convenience was replaced by a relatively minor annoyance. When it came time to write the post op scripts, the surgeon had to go the cabinet to get a blank prescription, or bring his own or remember to pick one up on his or her way to the dictation room.

Today, however, saw the birth of a new process, a better process, a safer process, at least in the eyes of these unknown and unseen health care gods. Today, when I went to get my blank script, it was locked away in a safe with a combination lock. One of the PACU nurses had to leave her fresh post op patient, unlock the safe and hand me one blank prescription. She also wrote my name in their “Blank Prescription Logbook.” The time, date, my name and number of prescriptions bestowed upon me was recorded for all posterity, perhaps to be reviewed at a later date by the Blank Script Gestapo, an elite team of healthcare administrators, Quality Assurance nurses and DEA agents. Physicians falling out at the either end of the bell curve will be called in immediately for interrogation.

My first thought was that this is another idiotic rule designed to take doctors and nurses away from the task of actually attending to the patients under their care. Therefore, I made the following proposal:

The PACU should hire a nurse whose sole responsibility would be to guard the safe where the valuable scripts are kept and to dispense them to those physicians deemed worthy. Certainly such an important position deserves an equally lofty title: High Priestess of Prescriptions, Holy Guardian of the Pad. Such a vital post would warrant special attire, perhaps a leather tunic adorned with golden spikes, gold amulets, hair braided with triplicate prescriptions and combat boots, accompanied by two pit bull terrier guard dogs and fully armed with sidearm, sword and syringes filled with propofol. A bit extreme one might think, but the post of HPP/HGP is one that should not be treated lightly. The High Priestess should be fully equipped to handle any sort of assault on the holy scripts.

In addition an altar would be erected and offerings left to our sacred guardian. Donations to the Holy Order of Prescription Priestesses would be obligatory of any individual wishing to receive the favor of a script from the Holy One. And, should the hapless physician need to prescribe more than one medication, the necessary offering would, of necessity as these printed pads carry great value, increase exponentially. Monetary offerings, jewels or animal sacrifice would all be accepted.

Should this pilot program be successful, as demonstrated by the surgeons developing appropriate rise in blood pressure, pulse and frustration level, a protocol would then be developed and the program presented to the Department of Health and  Human Services. The protocol, once fine tuned, could then be administered under the Affordable Care Act as “Meaningful Use”.

The cult of Priestesses would grow, the patient population would be protected from unscrupulous physicians purveying unnecessary prescriptions and the world would be a far safer place.

David Gelber is a general and vascular surgeon who blogs at Heard in the OR and author of Behind the Mask.

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  • David Lawrance

    The securing of script pads is an accreditation requirement that makes sense. You should treat them as well as the cash in your wallet. Surely you could find a way to keep some on you if you need them, rather than building an alter.

  • Zachary Leonard, MPAS, PA-C

    HAHAHA. Very will written. As a new graduate, it was not long ago I was
    rotating through the OR for surgery. The Rx pads were always put away in
    drawers, but not locked up. I can certainly see how having to grab a
    nurse to unlock them would be a huge inconvenience. I know in AZ, the
    medical board sends the docs a detailed profile of their prescribing
    habits…comparing you to other docs…making sure you fall within the
    bell curve. What are things coming to these days?

  • Kristy Sokoloski

    Very well written and really made my day. Thanks for the laugh.

  • Scott Soefje

    As much as you would like to think people will not steal prescriptions pads, it does happen. There is a rash of forged prescriptions on the East coast this summer and fall. All are using prescription pads stolen from a local health system. All are being written for the same long acting pain medication. The local police believe it is an organized group that is systematically stealing prescriptions.

  • Carah

    This made me smile. Love the satire!
    I will say though that I have learned that just because YOU do the right thing does not mean THEY (everyone else around you) will do it as well.

  • newake

    Our hospital had a pharmacy call back, and one of the scripts that were falsely written were from our PACU pad.

  • Suzi Q 38

    I love the humor.
    In reality, there are patients and health professionals that steal those pads and forge them.

  • SarahJ89

    How about you surgeons start paying attention to the amount of pain medication you prescribe? I broke my arm and ended up with two prescriptions for a total of 50 vicodin and oxycodone. I never filled either of them because we still had 8 oxycodones left over from my husband’s partially filled post-op scrip. He’d only used 4 of the whopping 20 on the prescription. After waiting a week to have my fracture pinned together and going through surgical recovery we still have a couple left over. And I still had those two scrips–and a prescription addicted neighbor two doors away from me and a mortgage payment due. I won’t kid you, it was a temptation to fill those scrips and sell them. I didn’t, but I certainly could have very easily.

    Want to know about how our prescription drug problem has blossomed? Look in the mirror.

  • Emilie DiChristina

    Great humor, but seriously….where are you practicing that doesn’t allow you to log in, write your scripts and have them sent electronically, or printed with your signature right there?

  • W Joseph Ketcherside, MD

    Cute to have a retro posting. All my docs can ePrescribe their post-op meds from any computer or their iPad if they have it with them. From any place, any time. Nobody needs to unlock anything. If it’s a controlled substance it will print right out on the special paper, if not then it goes to the pharmacy of choice directly.

  • Laura Dunn

    I truly enjoyed that!

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