Discontinued/held current medsor never started home meds

[nightshift82]

Our hospital years ago would send a message after 3 days of a "held" medication to make sure it was to continue to be held or did it need to be restarted. About 7 yrs ago this was stopped and if a med was ordered to be "held" then it was automatically dc'd. Here are a few problems that I have encountered and it is probably more of a problem due to the staff not having the HX of the patient. More of us are 12hr now and the Attendings are no longer in house we have hospitalists.

Patient1 comes in with

Patient 2 comes in resp arrest from the floor. Intubated. Tx'd for pneumonia. Had been on BB. Initially hypotensive. All floor meds held. Does well and is weaning VS WNL and no pressors day 4. Remind Chrg. AM that will need to be retarted on BB. Off for 3 days and find pt w/HTN and SVT needed esmolol gtt......

Patient 3 elderly woman comes RR team due to pulm edema. Post op day 4 with NS @ 150/hr. Pt had been also taking po fluids. Lasix was initially held due to OR but never restated plus IV NS @150/hr.

Is there some type or prompt or documentation of dc'd med list or home meds that were nver started that your hospital uses to prevent things like the above from happening? Is the MD required to review this? The problem is the patients move about the hospital so often you just don't know them that well anymore. All the Med Rec forms in the world won't stop this from happening. Sad for the patients and $ with longer hospital stays. Need to be a CSI and somedays there is just not enough time.

Any suggestions on how you prevent this from happening @ you hospital would be greatly appeciated.

[bamagt]

When an MD "holds" a med it is automatically dc'd by pharmacy to prevent this info from getting lost in report to the next nurse or one nurse not writing it on the MAR. The MD should write it on his progress notes or something so that they will remember to restart it when the time comes.

We don't have much problem with it now that the med's are automatically dc'd.

[nightshift82]

The same happens for us. The "hold" becomes a automatic dc but the problem is just that...sometimes it needs to be re-ordered and when that does not happen it can cause the problems I described. I was wondering if others had the same problem and how they handle it. We have so many hospitalists it can cause problems and even more so when the staff don't have the same patients to provide a HX.

[clarkheart]

Our hospital has a policy that requires the admitting physician to acknowledge and actually sign off on a list of their home meds that was obtained at admission. The pharmacy follows up on this and flags the physician if there any interactions or questions regarding past home meds and current inpatient meds. When the patient is discharged the discharging physician and nurse have to sign off on a list of those active home meds again. This policy can be a real pain sometimes but it has maintained better consistent care.

[nightshift82]

We also have the Med Rec form (in use for 3 yrs) and it is put into the order section fro the MD but it is a joke because the person who signs is the nurse. We don't fax it to Pharmacy but some told me we may be doing that soon. Does the MD sign it before you fax it to Pharmacy? How did you get the MD's compliance? Any suggestions about dc'd meds in-hospital that might need to be restarted? Maybe there should be a list of in-hospital DC med list that is generated 3day and the MD needs to review and sign off?

[AmyCardsNP, RN, NP]

It doesn't sound like you use electronic charting yet at your facility, and when you transition, it gets a lot easier to keep track of medications that your patient is on. Instead of having to flip through a thick paper chart, you can just click a button to see what medications the patient takes at home and cross reference with what medications are currently ordered.

Unfortunately, I don't have a good short term solution for you. Maybe you guys want to keep a copy of the patient's home meds under a tab of the chart that could be easily referenced each shift?

[nightshift82]

You are correct. We are about 60% electronic. Our MAR's and all drug rec forms for transfer are electronic for printing only. The original Med rec for home meds is not and neither are the MD orders and progress notes. We will be all electronic in about 2 yrs or less. Would be great to see and cross reference all current against dc meds. I was thinking about putting the Home rec list in a plastic sleeve so it could be found quickly. We currently do this red sleeve for blood permit and blue fro DNR. Thanks. I guess there is no real answer to this problem.