[sammarai]

I am a new HH nurse and had an admit this weekend that is weighing on my mind. This patient had a TKA done on the 30th and went to a rehab facility until she was discharged on Thursday. I saw her Saturday midmorning to admit to home care. She told me that she was to start taking coumadin and had a 30 day supply from the rehab hospital. She also said that she had 3 days of lovenox injections. Which I questioned her on at the time (even though I know sometimes they overlap until the coumadin can get into therapeutic range). She had started taking the coumadin on Friday and lovenox on Saturday. Well I called into the surgeon on Monday to give report and confirm about the meds. The nurse said they didn't prescibe it. So after repeated phone calls, the rehab facility finally admitted that yes they gave the pills to her but they didn't tell her to take them. I told them that was a major liability because this little old lady thought she was supposed to be on them and if HH hadn't been in there then she would have been on 30 days of coumadin without any PT/INR's done.

So my issue is that she was taking both lovenox and coumadin for a few days and maybe I should have stopped her on Saturday but I can never get any answers on Saturday from doctors. I guess I get so many admits where the information isn't in my packet, that I assumed they just didn't inform us of the coumadin at the time. I had already scheduled a PT/INR lab on Monday even before we found out about the coumadin issue and her INR as 1.4. I talked to the surgeon's nurse and I am having a nurse go out on Wednesday to draw a final lab just to check the INR one last time and also to make sure that the patient threw away the meds as I instructed on the phone. I am constantly worried about harming patients and this has me worried. Have I covered all my bases for my and my patient's protection?

TIA

[jnette]

Sounds to me like you did a FINE job.

It IS difficult on weekends.. when you get an admit and have to rely on the intake person's information.. or lack thereof. OR... that of teh rehab, hospital etc. conflicting with MD orders. MDs are not to be found on weekends, we all know that in HH.
At times, I've just had to call the ER doc to get orders to hold me over 'til Monday.

Our intake/referral nurse does an EXCELLENT job of getting ALL our needed info... but every now and then I might still run into a quirk no matter how much info she has given me, and certainly not due to any negligence on her part .. this occurs mostly on weekends. Of COURSE!

Glad you caught this and followed through. Kudos to you !

[sammarai]

Thank you for your response. I have a bit of obsessive /compulsive personality and I am constantly thinking of mistakes I have made or could make with a patient.

So you call just the local ER - to get orders on the weekend? I didn't get a great orientation so I feel like I am flying by the seat of my pants.

[jnette]

Originally Posted by sammarai

Thank you for your response. I have a bit of obsessive /compulsive personality and I am constantly thinking of mistakes I have made or could make with a patient.

So you call just the local ER - to get orders on the weekend? I didn't get a great orientation so I feel like I am flying by the seat of my pants.

I do call the ER in situations on weekends if I can't reach the pt.'s PCP.. which is usually the case on weekends. I can speak with an ER doc to get verbal orders to hold me over until Monday.. and the PCP will have received a fax form me by then to further address my concerns.

[AnnemRN]

I always called the PCP's on call physician to clarify or obtain orders. After explaining the situation, the doctor would give orders to cover until I could speak with the PCP on Monday.

[caliotter3]

When I was only a student doing my home health clinical, I found that one of my patients was taking a double dose of the the same drug under two different names, generic and trade name (digoxin). I called the MD and the agency and reported the situation and told the lady and her husband what was happening. I was shaking from that incident when I got home that evening. Goes to show that checking meds is something that should always be done. I always carry my med book with me so I can check everything. I think you did a good job of handling the situation.