Risk managers should always be aware of injured worker opioid use across their open claims and make sure that there is persistent clinician involvement with prescribers.
I am a complex pharmacy management nurse for Sedgwick. I want to share one of the many examples I see in day-to-day support for individuals who are prescribed opioids. One of the injured workers I was assigned to help was on several expensive medications for headaches: an opioid pain reliever, a sleeping pill, a medication for depression and a pill for erectile dysfunction. I was overwhelmed with the list of medications and realized when taken together they posed a dangerous risk to the patient. The doctor also indicated that the patient admitted to drinking alcohol. The implications for the man’s overall health and safety were alarming. I intervened immediately by trying to contact the physician and writing him regarding my concerns.
Next I identified an inconsistent urine drug screen, positive for opioids not prescribed and negative for the prescribed opioids and showing high alcohol levels. Shortly after that the patient had an accident during physical therapy and requested an increase in opioids. The doctor increased the medications without question. Making matters worse he also added two muscle relaxers, a stimulant due to drowsiness, and another sleeping pill.
At this point, the physician was still not responding to my continuing outreach so I sent a follow up letter outlining the health safety concerns. After a few more days of persistent follow up on the phone, the doctor called me. He had reviewed my letter and agreed with each of my points about the dangerous medications and the urine drug screen results. He outlined the changes he intended to make. I was overjoyed! Persistence had finally paid.
The doctor decreased the medications immediately and began the weaning process until all medications were discontinued completely. After the doctor addressed the non-compliance issues with the patient and shared his plans for the medication regimen, the patient decided to settle his claim. Even though the road to success was long and provided many obstacles along the way, perseverance was the key to success.
Abby McBroom RN
Complex Pharmacy Management Nurse