Don’t Talk to the Hand

I was reviewing clinical records recently for an excellent client. Well, most of the time they are excellent. But like every other client, past, present and future, they got a little careless when it came to coordination of care. A better name for care coordination I think might be simply talking to each other.

The particular chart I looked at was almost perfect. I was just getting ready to put it back on the shelf but had two questions. First, within the admission paperwork, there was mention of an area of redness on the heel of this patient. All subsequent notes noted that there was a wound on a finger. I thought it was sloppy charting. The second question concerned the patient being started on Lortab the week before discharge. Why?

So, before I called it quits for the day, I asked about the patient. As it turned out, the patient was scheduled for discharge and I had the opportunity to go with the nurse to see the patient. He was sitting up on arrival, fully dressed. I hated to inconvenience him but I asked if I could remove his sneakers and socks anyway. I managed to get the right foot exposed first and there was nothing to write home about. Just because I had come this far, I next turned to the left foot. With the help of an aide, I managed to take the snap shot below.

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Upon further investigation, I learned that the admitting nurse was only doing the visit as a favor to the agency. She documented the foot problem but didn’t report it. The aide saw the wound but assumed the nurse was aware. The LPN read about the wound on the finger but nothing written about the foot so she assumed it was a careless mistake like I did. The patient was cranky and frankly, didn’t like anyone removing his shoes and socks.

It would be easy if one person was to blame. But too many people knew about this wound. And everyone assumed that everyone else knew, too. It was a system failure with ominous results. However, this same failure to communicate exists in every client’s office at one time or another.

So could we all just please talk to each other?