Inefficiencies in Bremen's emergency medical services, resulting in unnecessary and painful fatalities
In Bremen, the on-call doctor service plays a crucial role in providing medical assistance to nursing homes and care facilities during off-hours. However, a recent case has highlighted a complex issue regarding pain management, particularly for residents like Mrs. Meyer, a 95-year-old woman with age-related dementia who resides in a nursing home in Bremen.
Mrs. Meyer's mental state has deteriorated, and she is nearing the end of her life. Sadly, she has been experiencing significant pain throughout her body. Yet, the on-call doctors, who may not be general practitioners or internists with geriatric experience, are not authorized to prescribe certain pain management medications, such as morphine patches, opioid substances, or other medications subject to the Narcotics Act (BtM).
The question arises: why can't BtM medications be individually stored as emergency prophylaxis in nursing homes? The answer lies in a series of reasons that prioritise regulatory, safety, and storage considerations.
Firstly, BtM medications are tightly regulated due to their abuse potential. Nursing homes must keep these drugs in secure, centralized storage under strict inventory control to reduce the risk of diversion or misuse.
Secondly, many BtM medications require specific storage conditions and safe handling procedures to ensure their potency and prevent unauthorized access. Allowing individual storage for emergency use complicates compliance with these standards and increases the risk of loss, theft, or improper use.
Thirdly, the administration of BtM medications typically requires assessment by qualified healthcare personnel to determine appropriateness, dosage, and monitoring for side effects or overdose. Emergency prophylactic use without direct supervision could lead to dosing errors or delayed identification of adverse events.
Fourthly, some emergency medications like naloxone require storage within strict temperature ranges and have limited viability after preparation or opening, making it impractical to store small individual doses in various locations or for extended durations without expiration or degradation.
Lastly, nursing homes are often governed by state and federal policies that restrict the distribution and storage of controlled substances and specify procedures for emergency medication accessibility. These rules usually mandate centralized storage with controlled dispensing rather than decentralized individual stockpiling.
The goal for Mrs. Meyer is to make her remaining time as pain-free as possible until she takes her final breath. Unfortunately, the potential need-based release of emergency BtM medications could not be implemented during her last night, leaving her in severe pain.
The on-call doctor service in Bremen is operated by the Association of Statutory Health Insurance Physicians. If you find yourself in a similar situation, you can reach the on-call doctor service at 116117 during regular doctor's office hours. However, on Saturday nights, when regular doctor's offices are closed, the on-call doctor service is the only option.
It is important to note that the potential use of emergency BtM medications would not be an interdisciplinary novelty, but an appeal to dignity and humanity. The case of Mrs. Meyer serves as a reminder of the complexities involved in pain management in nursing homes and the need for continued dialogue and improvement in this area.
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