Communicating patients medications from hospitals to home care.

[NRSKarenRN, BSN, RN]

jcaho states:

goal 8: accurately and completely reconcile medications across the continuum of care.

8a

there is a process for comparing the patient’s current medications with those ordered for the patient while under the care of the organization.

8b

a complete list of the patient’s medications is communicated to the next provider of service when a patient is referred or transferred to another setting, service, practitioner or level of care within or outside the organization. the complete list of medications is also provided to the patient on discharge from the organization.

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as central intake manager for large home care organization (1,500 referrals/month received), we historically have had difficulty with patients having their discharge instructions in the home at initial visit (~ 50% have in home). currently our referral sources are provding med list less than 10% time. snf's doing better job than hospitals in this regard.

biggest issue hospital case mgrs report is that discharge orders not written at time of order to refer to homecare; chart off the floor next day.

what are others doing/planning to meet this goal across the country? looking for ideas to bring to hospials within our health system, only one which has electronic medical records. does anyone have system in place that allows emr to generate discharge orders that automatically faxes to home care department...or is this a pipe dream?

[TazziRN, RN]

What fries me is that in the ER we are also expected to write down on a form not only the medications pts come in with, which is incomplete most of the time because pts barely remember the names, never mind the doses, but we are now supposed to provide the same list back with the new prescriptions written on them. Understandable for older pts who take half the pharmacy, but what about our little kids who don't take anything? They now have this huge piece of paper with one med written on it. And we're doing this 30 times in a day, since the turnovers in ERs are so high.

[Dorito, ASN, RN]

When I fill in as a discharge planner I put a post-it note on the discharge instruction sheet with instructions where to fax the info. Previously when I was a home health nurse this was a problem. Many times we didn't receive it from the hospital on discharge but often times the patient had a copy (even tho it may not have been real ligible) but usually it was better than nothing! Our records are electronic now and our home health nurses have been able to pull some of the info off on computer. Good luck to you. Many areas are having trouble with this safety goal

[GingerSue]

because pts barely remember the names, never mind the doses, but we are now supposed to provide the same list back with the new prescriptions written on them.

reading this just reminded me of my father's recent experience with medications - the only reason he even has a list is because I insisted that staff give him one upon discharge

then he gets his refills from a pharmacy arranged by the facility,

I check the label and all it says is "orange pill" - the pharmacy didn't even label his meds in these bubble packs {yes there are about a dozen or more different meds - not one of them labelled by the pharmacy} -

no wonder he doesn't know all the pills he is on, they aren't labelled {he was a health care professional himself and this is frustrating}

[Cattitude]

on the occasional time that i am there in the home to send the pt. to the hospital, i do send them with a med. list even though i don't have to. see my coordinators fax them to the floor later if the pt. is admitted.

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[color=#483d8b]however, i feel it is a courtesy and nice for the paramedics and er staff to have and if i am there, why not?

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[color=#483d8b]now, when they come home from the hospital, the med. sheets and discharge instructions are never correct. half the time the pt. ends up going back on most of the meds they were on before hospitalization anyway! very frustrating. and don't get me started on the prescriptions that are not written! oy!

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[color=#483d8b]i don't know what the solution is, my coordinators say the dc planners seem to be overly rushed, everyone's always busy, busy. whattya gonna do!

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[RunningWithScissors]

What irks me is when th epatient gives you a med list, then later on remembers things that weren't on the list, or else a day or 2 later says "well I stopped taking that last month!!!"

Patients are so unreliable, but it doesn't help in calling the pharmacy, because so many of them get meds from various pharmacies plus "samples from the dr's office".

[steelcityrn, RN]

Most of the time, the patients do have their discharge papers in their home for the admission. If they do not, I call the floor and have a nurse read them back to me (if the patient was not given it !). If a family member has it, I call them to bring it over, if possible. Many times there are medications they take not on the list. I only write the ones on the discharge, then call the m.d. as soon as I can to ask if they can resume these also( because just when you think they can...). That only takes a order to add to the P.O.T. Seems like the only time we get a discharge paper faxed to us with the medications, its usually a infusion case. The I.V. companies do a nice job with that, and I find them to be very thorough. It would also benefit the patient to have this paperwork in case fasting lab work was needed upon admission and not told to the intake person, on the discharge paperwork with the medications.