ER imposes limits, guidelines in battle against opioid addiction 

Starting Tuesday, the Emergency Room at Advocate Sherman Hospital in Elgin and its satellite emergency care facilities throughout the area will begin enforcing strict guidelines for use of various opioid painkillers, hospital officials said Monday.

With the guidelines in place, staff will not be prescribing long-acting opioid painkillers, won’t be giving more than a short dose of opioid painkillers and won’t be refilling lost, stolen or destroyed prescriptions. Emergency room caregivers will not be using the powerful painkiller Dilaudid, except for cases involving cancer patients or bad traumas.

The effort is in part based upon what already is taking place at Advocate Good Samaritan Hospital in Downers Grove, Advocate Sherman Public Affairs and Marketing Manager Jennifer Benson said.

“What led to this is concern with the nation’s opioid epidemic,” Emergency Medicine Dr. Christopher Frantz said.

Advocate Sherman Pharmacy Clinical Manager Paul Drahos said that Dilaudid is up to ten times more potent than morphine and provides a mild euphoria to those taking it.

Signs ER staff members have been noticing can be clues someone is coming to the emergency room specifically to feed an opioid habit, Sherman emergency room officials said.

For instance, when a patient specifically asks to push the Dilaudid into their system by injection, undiluted and asks for Benadryl, that’s a red flag, Drahos said. Another concern is when a patient claims to be allergic to other painkillers.

Emergency Department Manager and nurse Kristy Sheehan said such patients are told to fill out police reports and referred to their primary care physician for a copy of the original prescription for refilling.

Emergency room workers also are seeing a rise in recent years in the number of people who claim to be new to the area or who present false credentials in the hopes of getting painkillers. Ortega and the others also noted a rise in the number of phone calls to the ER related to painkillers and asking who is on duty, presumably in the hopes of getting a doctor who hasn’t seen them before. Others with painkiller addiction issues have been periodically peering into the ER windows to see who is on duty, Ortega said.

Sheehan noted that when alternatives to Dilaudid or opioids are discussed with people who may have addiction issues they tend to leave the ER instead of saying, sure let’s try that.

“We’re seeing people with opioid addiction issues from all walks of life,” Ortega said.

Sheehan said Advocate Sherman also is working with area physicians on a Complex Patient Program, looking for ways to assist with patients who make multiple visits to the ER instead of visiting their primary care doctor. Most of these patients are dealing with chronic pain issues, Sheehan said.

Ortega noted a June report from the Illinois Department of Health that points to how widespread the opioid abuse problem is.

The Department’s data shows 2,278 drug-related overdose deaths during 2016, which is a 44.3 percent increase over the 1,579 drug-related overdose deaths that were reported by the Department for 2013.

Of the statewide drug overdose deaths during 2016, more than 80 percent (1,826) were opioid-related. The opioid-related overdose deaths in 2016 represented an increase of more than 70 percent compared to 2013 numbers, and a 32.1 percent increase over the 1,382 opioid-related overdose deaths that were reported in 2015.

Sherman hospital officials have not yet determined whether signs alerting patients to the new guidelines will be posted. Hospital officials in some other states said they are required to take an approach that avoids discouraging people from getting care, said Emergency Room Physician Dr. Ryan Stanton in Lexington, Kentucky.

Stanton said interpretation of the federal Emergency Medical Treatment and Labor Act by regional offices of the Centers for Medicare and Medicaid Services in Kentucky and some other states prohibits some signage. That’s why Kentucky hospitals post guidelines inside cabinets and show them to patients after a consultation, he said.

Emergency rooms in Kentucky also are not allowed to treat chronic pain, and can only prescribe a 3-day supply of painkillers for injuries such as sprained ankles, he said. They also cannot use any long-acting painkillers, he said.

Emergency Medicine Doctor Jennifer Stankus of Olympia, Wash., said guidelines also are posted inside cabinets, similar to Kentucky.

“We also have strict monitoring of prescriptions in Washington,” Stankus said.

In Lubbock, Texas, Emergency Medicine Doctor Juan Fitz said many hospitals in that area work together and are not providing Dilaudid or Demerol.

Locally, Northwestern Medicine Senior Media Relations Specialist Kim Waterman said that that Delnor Hospital in Geneva and other hospitals with Northwestern have no strict protocols in place similar to Sherman’s guidelines but look at use of pain medication on a case-by-case basis, with a focus on reducing the use of narcotics.

Officials from Presence Saint Joseph Hospital in Elgin could not be reached for comment Monday.

Posted in Industry Updates, Opioid Epidemic