The locum tenens and prescribing guidelines
The locum tenens registrant can play an important role when instituting safer prescribing and risk mitigation. As a “second pair of eyes,” the locum tenens may observe new or dissimilar clinical presentations that do not support current medications or dosage―notably opioid and sedative prescribing that falls outside current clinical guidelines or outside College standards.
As a replacement and short-term physician, the time required to successfully engage patients, re-evaluate treatment options and implement patient-accepted change may be challenging. Furthermore, locum tenens may feel it is not their place to initiate change.
Locum tenens registrants should remember that they are in a unique position to challenge these notions. Advising patients of a concern may initiate an understanding that their current treatment might require further evaluation. In fact, documenting the rationale for these decisions may aid the returning physician going forward.
Locum tenens who feel a patient’s current medication regimen is a risk to his or her immediate safety can be agents for positive change. Some things to consider include:
If a patient has been given large dispenses of controlled medications, provide smaller (bridging) dispenses.
If a patient is on potentially dangerous doses of medications, or unsafe combinations of opioids and sedatives, initiate appropriate medication tapers. Sometimes patients may not have been asked about their desire to taper medications. If nothing else, documenting an initial discussion around safe and modest taper strategies may create opportunities for future engagement and safer prescribing.
Implement pharmacovigilance strategies when none are in place. This might include performing urine drug screening, pill counts or documenting a PharmaNet search.
For patients on long-term opioids or opioid agonist treatment, provide a Narcan kit and train family members on how to use it.
Initiate a referral to an appropriate specialist (e.g. pain, addiction or psychiatry) if the patient could benefit from such expertise and consultation.