You need to follow up with patients in pain

To comply with new pain management standards, you’ll need to address follow-up management to show continuity of care, warns Anne Llewellyn, RNC, BPSHSA, CCM, CRRN, CEAC, owner of Professional Resources In Management Education, a health care educational and consulting company in Miramar, FL, and an ED nurse at Imperial Point Medical Center in Fort Lauderdale, FL.

"The fact that a patient with pain has been treated will not be enough," she warns.

According to Llewellyn, surveyors from the Oakbrook Terrace, IL-based Joint Commission on Accreditation of Healthcare Organizations will look for the next step: How is the ED team ensuring effective follow-up care in order to address ongoing problems?

After relieving pain, give patients discharge instructions about pain management along with a referral for who/when/where to follow up if the pain persists, says Llewellyn. For many patients in pain, the ED is the entry point to the health care system, she notes. "Follow-up with the discharged patient will need to be done and documented to ensure that follow-up treatment did occur," Llewellyn says.

Many patients don’t follow up due to an inability to pay or an inability to get into primary health centers due to long waits, says Llewellyn. "Instead, they begin the rounds of various EDs in order to get pain medication due to continued pain," she says. "In doing this, they begin the downward spiral of ineffective care. That leads to increased cost to the health care system as well as poor quality of life for the patient."

In Imperial Point’s ED, the triage nurse makes a telephone call the next day to see how the patient is doing, Llewellyn explains. "The nurse asks if they got their prescriptions filled, if they had any problems getting a follow-up appointment, or need further explanation regarding their visits," she says. "We also ask how the care was for their ED visit."

This call allows the nurse to assist patients who need help with referrals for follow-up care, she explains. "If a patient tells us they tried to follow up but cannot get in for a two-week period, the triage nurse will place a call to the referring clinic or physician and expedite that visit," Llewellyn says.

Occasionally, patients don’t get prescriptions filled due to the cost of the drug, Llewellyn notes. "If we see this, then we let the ED physician know," she says. "Many times, they will write for a less expensive drug."

If a patient says he or she is worse or still in pain, you can instruct the patient to call his or her referral doctor or return to the ED to be re-evaluated, says Llewellyn. "This helps prevent the patient from falling through the cracks," she says.

Staff document all follow-up calls and record any problems in a log. If they give any advice, a record of that advice is attached to the patient’s permanent record. "If there are issues that arise, then a copy also goes to the nurse manager," says Llewellyn. "That way, he or she is prepared if a call comes in regarding treatment issues."

Every ED should give patients written instructions on how to care for themselves and how to follow up, says Llewellyn. "We give these instructions to each patient and keep a copy on the permanent record," she says.

This practice also allows the triage nurse to know what the patient was supposed to do, including follow-up visits and medications, says Llewellyn. "Many times, this information is reviewed and clarified during the follow-up phone call," she says. "The patients are very grateful for this information and the follow-up call."