Wednesday, June 30, 2010

TOFKAJCAHO, Making Medicine More Difficult for Decades

I want just one person to tell me why I shouldn't send Tony Soprano to visit whatever idiot came up with this.

*Editor's note... TOFKAJCAHO stands for The Organization Formerly Known as the Joint Commission on Accreditation of Hospital Organizations. They are now simply known as 'The Joint Commission', but I think that, like the musician Prince did, they should go to a simple symbol... I recommend a gloved finger covered with lube (though I really don't think they would use lube).


  1. "gloved finger covered with lube" symbol.

    Good one. Made me smile, which flared my acute toxic facial fibromyalgia. A 22/10 pain scale I say, and so it shall be, and TOFKAJCAHO agrees. I'm in so much pain I had to stop my work on the Frank Drackman for president in '12 cam-pain uh.. campaign.

  2. has anyone added opioids to a patient's allergy list to mess up with him/her?

    just wondering...

  3. Pain is NOT a vital sign!!!!! This drives me nuts! A vital sign is something that is VITAL for LIFE. Pain does not meet that criteria. Until I became a nurse, I thought having a brain was needed for life. Then I found out about TOFKAJCAHO.

  4. Pain as a Fifth Vital Sign!
    Yes, our JACHO standard is for this to be accurately documented.
    I had a patient a week or so ago that was drunk and on crack. (I know, I know, they are not supposed to be mixed but it prolongs the high by the production of cocaethylene! Cocaethylene, the ethyl ester of benzoylecgonine, is an active metabolite formed as a result of simultaneous use.) I digress! Anyway he had a wrist fracture that required reduction. (It was on his drinking hand!) Just before we administered our conscious sedation, (A combination of saline and brutane!) Just kidding, a little bit!) the nurse stopped everything and asked this patient with an alcohol level of 320, what is your pain score? I think he mumbled something like ffffff____ or something like that. (I have said for years that the F neuron is always the last to go! With a GCS of 2.5 the F neuron is still functional) I think she wrote down 10.5/10!
    I agree with the nurse, a ridiculous law required a ridiculous comment. I congratulated the patient once he was sober and withdrawing and had an alcohol level of 220 for participating in our JACHO effort! He said, “Jack who?”

  5. Subtalar Dislocation of the ankle after a fall off a ladder came into my ER the other night. Rated pain as 5/10 not five minutes after the patient in the next bed rated pain from a viral URI as 10/10. Never been so happy to write a morphine order in my life. Damn near ripped his foot off of his leg and said 5/10. Resisted the urge to hug him and give him a blank script pad.

  6. You don't send Tony Soprano, he's the Boss, and shouldn't get his hands dirty, even if he did shoot his Cousin with a Shotgun, Asphyxiate his druggy Nephew, Strangle that rat who went in the Witness Protection Program, and remember that guy who hit on his daughter so he stomped on his mouth? My kind of guy.
    I'd send a couple of pipe-hittin Niggaz who'll go to work on the homes with a pair of pliars, and a blow torch...
    but thats just me


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  8. It's only really a question of vampires and werewolves, 911. The mob is so five minutes ago.

  9. I seldom even bother with the JACKO pain scale. I usually record what I think their pain level is. It took only a few belly pain patients eating Big Macs and talking on cell phones with 10/10 pain for me to abandon the idea.

    The idiots tell the triage nurse 10 because they think they'll get seen faster.

    I noticed that most sincere patients with real pain rate it at about a 7.

    It's not uncommon for a new ER nurse to get frustrated with a stubbed toe patient rating their pain at a 10 to try and clarify by saying: "No, a '10' would be if your arm got ripped off by a wood chipper".

    Invariably, the patient would respond: "Oh, then this is an 11".

    The O2 Sat is the 5th vital sign, the pain scale is touchy-feely useless liberal gobbledy gook.


  10. I thought "10" Pain was sliding naked down a 50 foot long razor blade bannister and landing in a tub of Rubbing Alcohol...
    Or doing pushups over a Mouse Trap...
    or getting Circumcised without Anesthesia...
    I see things in Black/White, Good/Bad, Ying/Yang, Jessica Alba/Elen Kagan terms.
    It either hurts or it doesn't.
    My favorite is the patients where its "Numb" and "Burning Pain" at the same time...

    Frank "No Pubic Option" Drackman

  11. Does a pain scale really tell you anything? I had a bout of pancreatitis and they asked me to pick a number. I'm not sure what they did with that number, though.

  12. Why, PeggyU I'll tell you what they did with your pain scale number.

    They wrote it down.

    That way when some "high heel clipboard totin' 'nurse' who can't start an IV" from JACKO came to review charts, she would see that it was filled in!

    That's what they did with it.

    Nothing more.

  13. I figured as much. I mean, shit, when I had to answer them between pukes, I thought someone might have had a clue!

    LOL! I just got it from a reputable source that a "10" on the pain scale equates to a 10-story wedgie.

  14. You can thank Purdue and Janssen for pushing such nonsense. "There is no ceiling on fibro pain management opiate doses."

    My ass.

    How come patients still report 11/10 pain every office visit (which is a couple times a week) on massive doses of every combination of drugs ever invented?

    JCAHO = sanctimonious overbearing fatsos in suits armed with government-issued power

  15. Well, I suppose in the sense that if you are dead you don't feel pain, it might be considered to be a vital sign.

    OTOH, we had a cat that had a neurological problem that was very much alive - but did not feel pain. You could step right on top of that cat and it wouldn't holler.

  16. Hey Doc,
    Why you always hatin on the JCAHO? They provide jobs for thousands of mentally handicapped adults every day.

  17. See my comment about federal employees. For all practical purposes the employees of JACKOFF are federal employees. Nothing matters but their ability to protect their jobs by finding inconsequential violations and creating new standards that will enable them to find more inconsequential violations.