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Based on interviews, observation and policy review, the facility failed to comply with 489.24 by failure to ensure there were no deterrents from seeking medical care for pain in the Emergency Department in the form of posted information sheets regarding management of prescription narcotics. (A 2402) The cumulative effect of this systemic practice resulted in the facility's inability to ensure that all patient pain needs would be met. The average daily census of the Emergency Department is 181 patients.

Based on observations and interviews, the facility failed to ensure all Emergency Department patients were not deterred from seeking medical care in the Emergency Department as a result of viewing the posted sign regarding management of prescription narcotics. The average daily census of the Emergency Department is 181 patients.

Findings include:

On 2/12/14 at 3:26 PM, a sign regarding the use of narcotics and other controlled substances was observed attached to a pillar in the emergency department waiting room.

A tour of the hospital's Emergency Department (ED) was conducted on 02/14/14 beginning at 1:15 PM. Upon entering the Emergency Department waiting room, a sign was observed with language entitled "Use of Narcotics and Other Controlled Medications in the Mercy Medical Center Emergency Department and STATCARE Urgent Care Facilities" Verbatim on the sign read as follows:

For your safety, we follow these State of Ohio guidelines when prescribing narcotics or other controlled substances:

1. We are trained to look for and treat acute medical problems. We use our best judgment when treating any medical condition, and follow all legal and ethical guidelines.

2. We typically do not prescribe narcotics or other controlled substances for chronic conditions if you have already received such medication from another healthcare provider.

3. We may contact your primary care provider to discuss your care. If you do not have a primary care provider, we will provide you with a list of those providers in our area.

4. We may provide only enough medication to last until you can contact your primary care provider. We will prescribe pain medication with a lower risk of addiction and overdose whenever possible.

5. We will ask you to show a valid photo ID (like a driver's license) when you check into the emergency/urgent care facility or before receiving a prescription for narcotics or other controlled substances. If you do not have a photo ID, we may take your picture for the medical record.

6. We may ask you to give a urine sample before prescribing narcotic pain medication or other controlled substances.

7. Health care laws, including HIPAA, allow us to request your prior medical records and share this information with other healthcare providers who are treating you.

8. Before prescribing a narcotic or other controlled substance, we may check the Ohio Automated Rx Reporting System (OARRS) or a similar database that tracks your narcotic and other controlled substance prescriptions.

9. For your safety, we do not:
a. Routinely give injections of narcotics or other controlled substances for chronic conditions.
b. Refill stolen or lost prescriptions for narcotics or other controlled substances.
c. Routinely prescribe more than a 3 day supply of narcotics or other controlled substance.
d. Provide Subutex, Suboxone, or Methadone treatment or prescriptions.
e. Prescribe long-acting or controlled-release pain medications such as OxyContin, MS Contin, Duragesic, Methadone, Exalgo, and Opana ER.

10. Frequent users of the emergency/urgent care facilities may have Care Plans developed to assist in improving their healthcare. These plans may include avoiding medicines likely to be abused or caused addiction.

11. If you need help with substance abuse or addiction, please call (800) 788-7254 between 8 a.m. and 5 p.m. Monday through Friday for a confidential referral for treatment options.


On 2/14/14 at 1:17 PM, Staff J was interviewed regarding the above posting. Staff J confirmed the sign was currently posted in the Emergency Department waiting room.

On 2/18/14 at 10:45 AM, Staff B reported the facility had removed the posting from the old Emergency Department waiting room. Staff B reported the new Emergency Department waiting room opened January 18th and the sign was posted in error.

On 2/18/14 at 10:45 AM, Staff B provided a copy of facility communications regarding the removal of pain signs in the Emergency Department from 01/15/14 and 01/01/14. The communications stated the Staff B had instructed Staff P to take down the sign.