Larry came home from the hospital where he was treated for a lung infection. He spent 3 days in the hospital receiving IV antibiotics and recuperating from pneumonia. On the last day he received nebulizer treatments to help clear his lungs.
The morning after Larry was discharged home, his home health nurse came to evaluate Larry. An important part of every health care evaluation is the medication review. The nurse gathered all of Larry’s medications that he had been taking prior to going to the hospital and compared the list from the hospital discharge papers.
What the nurse discovered during the evaluation was that Larry had a change in the amount he is to take for three of his medicines and he had 3 new prescriptions. Only 2 prescriptions were filled at the pharmacy. Larry was not using the nebulizer and he took the wrong dose for 3 other medicines this morning. This happened because of adjustments made at the hospital due to his current health condition.
Larry has COPD and the machine helps put the medicine into the form of a fine mist that will reach to all areas of his lungs to make him breath easier and cough up mucus from the infection. Nebulizer medication may be used in addition to or in place of inhalers. Some people aren’t able to use inhalers properly and the nebulizer medicine gets to the lungs much more efficiently with the machine. In Larry’s case, he was to use the nebulizer four times a day when he is at home, and if he must be away from home, he can use his inhaler occasionally instead of the nebulizer as it’s more portable. The nebulizer helps open all of Larry’s airways so his lungs can clear the infection.
The medicine for a nebulizer machine comes from the pharmacy. Nebulizer machines come from a medical equipment company and is usually covered under Medicare and other insurances with a doctor’s prescription. In Larry’s case, the hospital sent the prescription to the pharmacy but they didn’t send a prescription for the machine to a medical supply company.
When Larry left the hospital, the nurse who reviewed the doctor’s discharge instructions mentioned that he should continue his breathing treatments. She assumed he had been using the nebulizer before. She did not do a complete medication reconciliation prior to his discharge. That was the first mistake. The second mistake was that Larry was distracted. He mentally prepared and organized all of his belongings for the return home. He did not recognize the importance of the discharge instructions. Larry missed the important details so that he would get his medication routine right when he returned to the safety and comfort of home.
Medication reconciliation is a process that all medical professionals need to follow in an organized way to make note of any differences between the way the medication was intended to be taken and how the individual is actually taking it. Larry and the nurse, if truly doing a medication reconciliation would have discovered that Larry hasn’t used a nebulizer machine before and the problem would have been fixed before he went home.
In another case, Theresa is at the doctor for a check up and her blood pressure is high today. Theresa is to take a blood pressure medicine three times a day. She understands that she is to take the medicine with each meal. In the doctors office the nurse asks her if she is taking her hydralazine. She answers, “yes”. “When do you take it?”, asks the nurse. “At each meal”, Theresa replies. While the nurse is satisfied with this answer, what is missing is finding out the times she takes it. More digging reveals that Theresa gets up at 11:00 am. She eats and takes her blood pressure medicine at 11:30 when she gets a Meals-on-Wheels delivery and then has soup and a sandwich at 5:00 at which time she takes her pill again. She never eats three meals and is actually only taking two doses a day.
Poorly controlled blood pressure may result in a stroke or heart damage, further affecting Theresa’s health and ability to live independently. As high as one-third (30%) of all patients find themselves back in the hospital less than a month after a hospital stay. Medication errors are one of the highest causes of repeat hospitalization stays.
Brown bag medication reviews completed by doctors, nurses, and pharmacists often reveal problems. “Out of 10-15 brown bag reviews, only 2 were accurate.”. People were also found to take duplicate medications because they were taking both the generic and brand name for the prescription. Filling medications at the same pharmacy every time will prevent these errors as pharmacists watch for these type of errors when filling prescriptions.
The bottom line, most important result of any medication review is safety. Patients who continue to take medications inaccurately are more likely to require a return admission to the hospital and possibly experience life-threatening medical harm requiring a stay in an intensive care unit.
How can you prevent medication errors from occurring?
1. Keep a current list of your medications in your wallet.
2. Take all of your medications in a bag with you to each doctor visit. Also, pull out your medication list and review it for accuracy as your pill bottles are reviewed.
3. Update your medication list every time a medicine is changed, added, or stopped.
4. Use one pharmacy to fill all of your prescriptions.
5. Pay attention to instructions provided by your health care provider.
6. Be comfortable asking questions about anything that you don’t understand when explanations are provided for you.
7. Request written directions to take along with you, just in case you forget parts of the instructions.
8. Ask someone to attend all doctors visits with you. Ask your companion to listen, take notes and ask questions during the visit to help you recall information later.
9. Review all the information provided you with your companion after you return home. Take notes about any followup questions you may need to talk about with your health care provider.
10. If you are hospitalized and are returning home, ask your family member or designated driver to be there with you for the discharge paperwork review and to help answer any questions at that time.
11. Don’t let the discharge instructions get buried beneath everything once you return home. It is a busy, hectic process to get reorganized when returning home from the hospital! Reviewing the instructions several times is important. There is so much information to remember, it can be overwhelming. Be kind to yourself and review the notes a few times knowing you are taking good care of yourself.
12. Request Medicare-certified home health agency services upon discharge home to assist you in the transition to home. If services weren’t started right after you leave the hospital, you may call your doctors office and request home health visits. The visiting nurse will assist you in assuring that you are taking medications accurately and provide more training and teaching about your health condition(s), medications, diet and fluid management, pain management, and lifestyle changes that are needed to help you remain healthy and avoid a return trip to the hospital. The nurse will make recommendations for other in-home visits such as Physical Therapy, Occupational Therapy, Speech Therapy, Social work services, and even home health aide services to assist with personal care for a short period as you recuperate at home.
13. Always schedule and keep follow-up health care provider/doctor appointments. An appointment to your health care provider is important to be sure that you are recovering well. Your health care provider may make further adjustments as needed to help you continue to recuperate at home.
These tips will prevent many complications in your health, no matter what the medical diagnosis is. “There’s just so much information to absorb”, as aptly put by Dr. Beth Ann Swan, Dean of Nursing at Thomas Jefferson University. In the end, communication is the key ingredient. We rely on each other. To your good health!