Bioethics lecturer David Hoffman co-presented a talk titled, “What is the Maximum Permissible Dose of Morphine or Fentanyl? A Question of Physician Compliance and Quality of Care,” at the Compliance Institute on April 19th.
The indictment of an Ohio physician on 25 homicide charges “highlights the responsibility of compliance officers to monitor excess doses of pain medications that can produce life limiting levels of respiratory depression,” said Hoffman. The presentation explored the importance of hospital medication dispersal systems and their ability to set as well as override limits on the amount of pain medication for patients.
There is, however, no one-size-fits-all answer for what constitutes an effective vs. a lethal dose, Hoffman noted, adding that the role of compliance officers is to “learn to say no by saying yes.” He also covered issues surrounding discharge and end of life issues surrounding patients with addictions.
Hoffman suggests medical staff consider tracking information such as top orderers of opioids by frequency and volume and the highest doses of opioids each month. Asking the hospital IT department for exception reports and checking on the frequency of system overrides for opioids above the institution's baseline could also be effective. Hospitals might also track “correlation of tox screens to opioid prescriptions” and “discharge from care vs. referral of non-compliant pain management patients.”
In summation, Hoffman outlined the basic principles of what patients should receive. These are: “care not scorn, treatment not judgment, referral not discharge from care, and all the pain medication they need, and no more.”
Hosted by the Health Care Compliance Association for healthcare professionals such as compliance officers, nurses, ethics officers, and risk managers, the Compliance Institute covers complex issues facing compliance professionals today.
Learn more about Columbia University’s Bioethics M.S. program.
