Formalize drug-seeker list; minimize who can access

The first step in formalizing your list of drug seekers or other frequent visitors to your ED is to avoid any disparaging names for them or the list, says Joel Geiderman, MD, FACEP, co-chair of the ED at Cedars-Sinai Medical Center in Los Angeles.

Don’t call it a "kook book" or "problem patient file." Instead, use a more neutral term such as "habitual patient file," he suggests.

"The labeling is important because you start off on the wrong foot if you use a disparaging term for these patients," he says. "The list should be free of personal judgment or nasty remarks about the people, so start by giving it a name that doesn’t label them that way."

Geiderman’s research shows that most EDs keeping lists do so without much control over who goes on the list or how it is used.1

If you keep a list, which he doesn’t necessarily support, you must employ tight controls to keep it from being misused, he notes.

Here are some of the steps employed by the ED at Cedars-Sinai:

  • Names of suspected drug seekers are forwarded to a semiweekly meeting of attending physicians, where they are discussed confidentially. The physicians discuss the patient and decide whether to place the name on the habitual patient list.
  • The file is maintained on the computer system, and physicians can access it with a password from any ED workstation. Unlike medical records, only physicians can access the file.
  • The list is used as a resource only. Physicians are free to exercise their own judgment in determining how to provide treatment for the patient, using the information in the file as supporting data.
  • Cedars-Sinai does not share information from the file with other institutions. The only exception is for a private physician who has an established relationship with the patient.

Reference

1. Geiderman JM. Keeping lists and naming names: Habitual patient files for suspected nontherapeutic drug-seeking patients. Annals of Emerg Med 2003; 41:873-881.