Part of the comprehensive care we provide at PartridgeGP can include visiting Residential Aged Care Facilities. While it is a pleasure and a privilege to serve our older patients, we MUST remember certain rules:
You MUST see your patient (face to face or via telephone/telehealth) for them to claim a Medicare Rebate
(You may spend some time with their notes and then a brief consult – your patient can claim a Medicare rebate for this, but there is no time able to be claimed for reviewing the notes without attending to your patient)
There is NO such thing as a QUICK LOOK
Older patients are frail – do not prescribe powerful medications (opioids, benzodiazepines, anti-hypertensives) without careful consideration and review.
The story below highlights this…
EVERY square is 80mg of Oxycontin a day!
I have omitted the identifying details in the story below – it is not intended to malign any particular doctor or area, just to highlight the dangers to doctors, and most importantly, our valued elder patients.
A GP has been suspended for six months after prescribing oxycodone to a nursing home patient they didn’t examine and later prescribing fentanyl patches to the same patient without checking their drug history. The doctor was visiting another patient when nurses asked him to prescribe a painkiller for an elderly resident.
The doctor, who had first consulted with the patient two years ago at the practice, did not examine or check records before prescribing oxycodone 5mg four times daily. Authorities heard that, five days later, the nurses incorrectly told the doctor the oxycodone was not working, so the patient was then examined and prescribed a 50mcg/hr fentanyl patch.
The patient subsequently fell unconscious for several days. When the doctor was called, they diagnosed a stroke and prescribed morphine for palliative care. The patient died soon after.
An expert GP witness said the fentanyl patch was unnecessarily strong and the patient’s ‘stroke’ could have been a narcotic overdose. “In the presence of pin-point pupils which are reactive and in a situation where a patient has recently been administered a narcotic analgesic, it would stand to reason that narcotic overdose could be a diagnosis”.
It emerged during the tribunal hearing that there were no records at the nursing home that the patient received the oxycodone the GP had prescribed.
The tribunal said that the nurses incorrectly told the GP that the oxycodone was not working and they should have also asked for a medical review when the patient fell unconscious after the fentanyl script was administered.
But the tribunal stressed that the GP should have examined the patient before prescribing oxycodone and should have checked the patient’s medication chart before prescribing fentanyl to determine whether they were opioid naïve. Even had they received oxycodone, 50mcg/hr fentanyl was still “excessively high”, the tribunal concluded.
The GP admitted the main charges, although claiming the nurses were told to make contact if the patient’s condition changed after the fentanyl patch was applied, which they did not do.
The tribunal found the GP guilty of professional misconduct and a suspension of six months was advised, with the further condition of being banned from prescribing opioids unless extra education modules were completed.
This appears to be a Swiss Cheese problem. The Swiss Cheese model of accident causation, originally proposed by James Reason, likens human system defences to a series of slices of randomly-holed Swiss Cheese arranged vertically and parallel to each other with gaps in-between each slice.
Reason hypothesizes that most accidents can be traced to one or more of four levels of failure:
- Organisational influences,
- Unsafe supervision,
- Preconditions for unsafe acts, and
- The unsafe acts themselves.
In the Swiss Cheese model, an organisation’s defences against failure are modelled as a series of barriers, represented as slices of the cheese. The holes in the cheese slices represent individual weaknesses in individual parts of the system, and are continually varying in size and position in all slices. The system as a whole produces failures when holes in all of the slices momentarily align, permitting “a trajectory of accident opportunity”, so that a hazard passes through holes in all of the defences, leading to an accident.
Tomorrow, we will go through all the ways that PartridgeGP does things a little differently.
PartridgeGP works with you to help you make your best health decisions, and we won’t back away from being your companion, guide, advisor, and sounding board through your health journey. We pride ourselves on great communication and we’re ready to share our professional skills and knowledge with you.
Let us be the missing piece in your puzzle! This is only MORE important now, in the time of a global pandemic with a new vaccine on the horizon. The way forward is clear: make your appointment with us conveniently online right here – or call our friendly reception team on 82953200.
Better, for you.
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For everyone, we believe that having a usual GP or General Practice is central to each person’s care and recommend that people with any health issues that come to the attention of other health professionals should be advised to attend their usual GP or General Practice rather than a specialised service (ie a place not providing the holistic care a specialist GP would). If they say that they don’t have a usual GP or general practice, they should be helped to find one and to actually attend it. Call PartridgeGP on 82953200 or make an appointment online here.
(Hat tip: Dr Oliver Frank)
Photo by Miguel u00c1. Padriu00f1u00e1n on Pexels.com
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If you are a great GP or a great Allied Health Professional, and you want to serve your clients or patients to the best of your ability, without worrying about all the non clinical things that get in your way, lets talk. Call Mrs Hayley Roberts on 8295 3200 and have a coffee and chat with us as to how PartridgeGP can help you to help others.