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Managing Medications

I know that there are a million things that can go wrong with a patient in the home but for some reason, I am stuck on medications this week.  For one thing, we have some control over the medication error variables.  And I do see a lot of ways that nurses can prevent errors.

One of my clients had this brilliant idea of calling LSU and asking for a pharmacist to sit in on weekly case conferences.  As a result, they now have fifth year students sitting in on case conferences to review medications with the nurses.  It doesn’t cost the agency a thing and I think it will be a great experience for the pharmacists to see first hand the plethora of medications patients take in the home environment.

Another tool that I have been using is a free iPad/iPhone program from Medscape.   Without having to spell all the meds, I can enter in a patient’s med profile in a matter of a minute and check for interactions and precautions.  There are two download options available.  Because I do not have a 4G iPad, I downloaded the database and it works for me even when there is no wireless.  I regularly get notices to update the database so it apparently is kept current.

As nurses, we pretty much know everything there is to know about a drug before we swallow a pill.  We should hold ourselves to the same level of certainty when it comes to medicating patients.  In the worst case scenario, if you have no iPad, iPhone, old fashioned drug book, it is a law that the pharmacy’s phone number be placed on any prescription bottle.  Call them!

Another resource I review almost daily is emailed FDA Medwatch alerts.  You can click on the link.  My personal suggestion is to limit your alerts to drugs and medical equipment because otherwise you will be flooded with emails.  I made a separate folder for the FDA.  Last week I learned that some pills labeled as hydrocodone didn’t actually have hydrocodone in them and another batch of hydrocodone with acetaminophen had more acetaminophen than the label said.   I get anywhere from two to ten alerts each week.  I think it is good information.

While all of these resources are good, it occurs to me that the biggest problem I see when reviewing clinical records is an apparent lack of concern regarding medications.  I don’t fully understand it.  I think there are still nurses who think if a doctor prescribes a medication, he must know what he or she is doing.  That is expecting too much of physicians who have patients with multiple doctors and pharmacies.  Often it is the home health care nurse, in the home with all of the medications who has the only true picture of what the patient is taking.  When you start expecting even your best doctors to be perfect, think back to the last time you made an error judgment or took a short cut that resulted in an undesirable outcome.

I know for me that was this morning.   And I like having people around who cover my back.  Remember that the quality of nursing starts in the field.  And it is much easier to improve the quality of nursing in the field if the agency has a culture that promotes excellence.  So whether you are in the field or behind a desk, get serious about medication errors.

Your comments are welcome below as are your emails.

2 Comments Post a comment

  1. Awesome stuff here, Medication errors send patients back to the hospital as well as causing falls. I have many clients who separate the meds”Currently NOT used” into a brown lunch sack(Grocery sack for some patients!)

    We often forget that we as home health nurses are the only medical discipline that goes into the patients living environment and sorts out the good bad and ugly of the situation to the benefit of the patient.

    And Medications are almost always first on the list.
    Great article

    June 30, 2011

    • Thanks. I like the idea of separating unused medications by placing them in a different bag. Depending on the patient, sometimes, with the family’s cooperation, the bag can be put out of sight of the patient. This prevents confused patients from finding them and eating a handful of discontinued without throwing out what may be hundreds of dollars worth of medications. It is supposedly illegal to tamper with the label that a pharmacist puts on a bottle but that has never stopped me from marking high risk drugs with a Sharpie especially pain meds. This prevents patients with multiple orders from multiple physicians from taking duplicate drugs that add to the risk of falls or over sedation.

      June 30, 2011

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