May I Have Your Attention, Please?
I’ll be brief here. I am very, very busy and really don’t have time to blog today but I have a message and an insatiable desire to share it.
Ladies and Gentlemen: Please give your patients’ medications the attention required to ensure a safe and therapeutic outcome!
In reviewing clinical records for multiple clients, these are just a few of the things that I have seen with alarming frequency in the recent past:
- An abundance of Tylenol ordered to the extent that patients took all that was ordered, they would likely die of liver failure. But most don’t die of liver failure, so that begs the question of whether or not we are really checking medications as well as we should.
- Far too many narcotics and sedatives in the elderly population. If you stop and consider that falls are the number one cause of accidental death in persons greater than 65 yrs of age and that narcotics and other sedatives can only increase their risk of falls, all the little pieces start to add up to a lot of dead Medicare beneficiaries. If that doesn’t disturb you (and the fact that it might not, disturbs me), then remember, you cannot bill on patients after the date of death.
- Grossly inappropriate doses on the plans of care. What’s wrong with these orders?
- Scopolamine 10 mg i PO three times a day for dizziness.
- Lortab 10/650 one or two tabs every 4 hrs prn pain
- Duplicative drug therapy. Seriously, how many inhalers does one patient need especially if they all contain albuterol? Does Prilosec work better with Nexium enhanced by Zantac? Did I miss an FDA alert?
- Finally, how is it that a patient can go for an entire episode with no new orders for medications and yet the next 485 med list is radically different from the prior one? Does the patient routinely go to the doctor the day before the recert visit and get his meds changed? Surely, we aren’t missing any changes along the way. That would be so unlike a good home health care or hospice nurse.
Sorry for the sarcasm. I am barely keeping my head above water with all these clinical record reviews. One thing for certain is that as more and more agencies go to computerized point of care charting, bad information is going to be even more readily available to caregivers. And that scares me.
So, do me a favor. Write a comment about a medication error or potential error that you caught before harm was done to the patient. Tell the rest of us how you caught it and how you fixed it so we can learn, too.