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I need input from my fellow INPATIENT PAIN MANAGEMENT PA's, please!


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Hello, and thanks for reading this! I'm looking for answers from a very specific group of physician assistants! I work for a 500 bed hospital as their inpatient pain PA. My requirements include handling all inpatient pain management consults, managing post-op epidurals and PCA's, and daily rounds, among other things.

 

I'm currently in the middle of a crossfire between pain management staff and admitting physicians. I don't want to say much more about the issues so as not to skew results. I'm hoping my fellow PA's can provide me with a little information.

 

If you are a physician assistant who handles INPATIENT PAIN MANAGEMENT for a hospital (our outpatient side isn't affected), can you please answer these questions?

 

1. Yes or No - Do you assume management of the patient's pain issues while they are inpatients? This includes writing orders, daily rounds, etc.

 

2. If you answered NO to question 1, what is your role in terms of inpatient pain management?

 

3. If you answered YES to question 1, do you assume management of your inpatients as outpatients upon discharge?

 

4. If you answered YES to question 1, do you write for the patient's pain medication upon discharge?

 

I thank you in advance for your help with these questions. I hope to hear from my peers as your input is very important to me. Again, thank you VERY much!

 

Sincerely,

 

Scott Petersen, PA-C

 

PS -- please let me know how many beds your hospital has. Thanks!

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Hello, and thanks for reading this! I'm looking for answers from a very specific group of physician assistants! I work for a 500 bed hospital as their inpatient pain PA. My requirements include handling all inpatient pain management consults, managing post-op epidurals and PCA's, and daily rounds, among other things.

 

I'm currently in the middle of a crossfire between pain management staff and admitting physicians. I don't want to say much more about the issues so as not to skew results. I'm hoping my fellow PA's can provide me with a little information.

 

If you are a physician assistant who handles INPATIENT PAIN MANAGEMENT for a hospital (our outpatient side isn't affected), can you please answer these questions?

 

1. Yes or No - Do you assume management of the patient's pain issues while they are inpatients? This includes writing orders, daily rounds, etc.

 

2. If you answered NO to question 1, what is your role in terms of inpatient pain management?

 

3. If you answered YES to question 1, do you assume management of your inpatients as outpatients upon discharge?

 

4. If you answered YES to question 1, do you write for the patient's pain medication upon discharge?

 

I thank you in advance for your help with these questions. I hope to hear from my peers as your input is very important to me. Again, thank you VERY much!

 

Sincerely,

 

Scott Petersen, PA-C

 

PS -- please let me know how many beds your hospital has. Thanks!

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This is a very good question for every pain management specialist. I am an Anesthesiology/Intervent Pain Mgmt fellow and have run across this same issue with several in house pain consults. We frequently see both acute and chronic pain consults and from my experience I would strongly encourage you and your department to NOT write any pain meds and DO NOT follow the patients in your clinic. You and your department are specialists and consultants and should therefore respond to consults accordingly. If you start taking the primary role of writing meds and following patients after discharge then your service will soon be filled with many drug seeking/abuse potential patients and your license will be at the mercy of every patient who cries "pain." If the consulting physician is concerned enough about his patient to consult you then they can take the time to write the meds;

 

To answer your question:

 

1. No we do not assume the management of the patient's pain issues with few exceptions (continious epidural or peripheral catheter) and no we do not rounds with few exceptions;

 

2. Our role is to make SUGGESTIONS; I would not expect a medicine doctor to write blood pressure or diabetes meds if he was consulted for uncontrolled HTN or DM; I don't know of any law prohibiting non-pain specialists from writing pain meds and if some adverse reaction or OD should occur based on your recommendations thenthe consulting doctor would not be liable so "I don't feel comfortable writting these meds" should not be an excuse;

 

3. The big question is follow up. 90% of in hospital consults are acute pain or acute exacerbation of chronic condition; Rule #1 start the patient back on their home pain meds; I can't tell you how many times we are called for pain and the patients chronic pain meds aren't even continued in house; no wonder they are in pain; Rule #2 generall make a 10-15% increase in short acting meds per day until pain is managed; We then provide with taper discharge instructions approx 10-15% reduction per day on short acting meds until back to base line meds; if the primary service needs help writting these taper doses which they usually do then we usually provide taper instructions as well; this way only a one time taper script upon discharge is needed and no follow up is necessary for med changes; they can continue getting their chronic pain meds from whoever wrote them;

 

4. No never write for the meds unless you want to take that patient on for life; Every doctor and extender with a prescribing license should know how to manage basic acute pain; you are there to just make suggestions for the management of more complicated cases;

 

You will not be liked for these policies but I don't like anyone else telling me who I have to write pain meds for and jeaporadizing my license; hope this helps;

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This is a very good question for every pain management specialist. I am an Anesthesiology/Intervent Pain Mgmt fellow and have run across this same issue with several in house pain consults. We frequently see both acute and chronic pain consults and from my experience I would strongly encourage you and your department to NOT write any pain meds and DO NOT follow the patients in your clinic. You and your department are specialists and consultants and should therefore respond to consults accordingly. If you start taking the primary role of writing meds and following patients after discharge then your service will soon be filled with many drug seeking/abuse potential patients and your license will be at the mercy of every patient who cries "pain." If the consulting physician is concerned enough about his patient to consult you then they can take the time to write the meds;

 

To answer your question:

 

1. No we do not assume the management of the patient's pain issues with few exceptions (continious epidural or peripheral catheter) and no we do not rounds with few exceptions;

 

2. Our role is to make SUGGESTIONS; I would not expect a medicine doctor to write blood pressure or diabetes meds if he was consulted for uncontrolled HTN or DM; I don't know of any law prohibiting non-pain specialists from writing pain meds and if some adverse reaction or OD should occur based on your recommendations thenthe consulting doctor would not be liable so "I don't feel comfortable writting these meds" should not be an excuse;

 

3. The big question is follow up. 90% of in hospital consults are acute pain or acute exacerbation of chronic condition; Rule #1 start the patient back on their home pain meds; I can't tell you how many times we are called for pain and the patients chronic pain meds aren't even continued in house; no wonder they are in pain; Rule #2 generall make a 10-15% increase in short acting meds per day until pain is managed; We then provide with taper discharge instructions approx 10-15% reduction per day on short acting meds until back to base line meds; if the primary service needs help writting these taper doses which they usually do then we usually provide taper instructions as well; this way only a one time taper script upon discharge is needed and no follow up is necessary for med changes; they can continue getting their chronic pain meds from whoever wrote them;

 

4. No never write for the meds unless you want to take that patient on for life; Every doctor and extender with a prescribing license should know how to manage basic acute pain; you are there to just make suggestions for the management of more complicated cases;

 

You will not be liked for these policies but I don't like anyone else telling me who I have to write pain meds for and jeaporadizing my license; hope this helps;

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Thank you VERY much for taking the time to reply! This is very helpful! Without giving too much identifying information, could you tell me how many beds are in the hospital program you're in and in what region (West, Midwest, South, etc) it's located?

 

I still hope to hear from other inpatient pain management PA's and get their input as well!

 

Scott

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Thank you VERY much for taking the time to reply! This is very helpful! Without giving too much identifying information, could you tell me how many beds are in the hospital program you're in and in what region (West, Midwest, South, etc) it's located?

 

I still hope to hear from other inpatient pain management PA's and get their input as well!

 

Scott

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#1 yes we do assume care for pain issues while he/she is an inpatient. Daily rounds, writing orders. Granted we get consulted for interventional cases mostly and a few "chronic meds" patient. I say we because it is me and two physicians in our outpatient practice.

 

#3 usually no. If we choose to follow them outpatient we will tell the patient to make a follow up with our office. If the patient asks to see us out patient I tell them to have their PCP make a referral.

 

#4 again usually no. The primary service usually does that, but will not tell the patient to follow up with us unless we communicate that we are going to assume care as an outpatient.

 

we usually do not get consulted for acute pain. it is usually someone that we are going to do a procedure for, epidural etc. we are a private practice that does consults for a 200 bed hospital.

 

Adam

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