A new report from the Office of the Inspector General for the VA has concluded that a lack of EMR documentation, as well as the shredding of prescription records and potentially inappropriate renewals of opiate prescriptions, are ongoing problems at the VA’s Medical Practice Clinic in San Francisco.
The report follows on a a similar OIG effort exposing an array of poor practices, including improper EMR use and inadequate patient monitoring, at its Memphis location, according to a story in EHR Intelligence.
The OIG’s research found that providers at the San Francisco clinic were failing to document prescription renewal problems in the EMR, and that they seldom completed a narcotic instruction note template for pain management patients.
Meanwhile, reviews of patient adherence to their regimen in screenings for possible abuse were conducted in less than half of the cases analyzed by OIG. Fifty-three percent of patient files reflected no documentation that a qualified clinician checked in on the patient’s pain management regimen, and one-third of patients did not have documented urine drug test to ensure that the patient was using the medication correctly, EHR Intelligence reported.
Also, the clinic used paper prescription request forms to share the status of renewal requests between one clinician and another — but these paper communications were later shredded and never became part of the patient’s EMR file, leaving a big documentation gap.
Perhaps the most egregious problem at the clinic arose due to the clinic’s otherwise understandable attempt to keep pain patients current with the medications, EHR Intelligence noted.
The clinic serves 10,000 patients using ten nurse practitioners and 30 part-time attending on duty physicians. Patients, who are allowed only 30 day doses of narcotics, had been getting renewal scripts from whatever part-time attending physician was available. Often, the attendings didn’t know the patients and in some cases had never met the patient’s in person when they wrote the prescription renewals.
In the wake of these findings, the San Francisco VA clinic will cease using attendings to review urgent script renewal requests and will migrate to the use of an opioid dashboard to manage such requests on the primary care side of the clinic.