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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