Home med lists make me crazy. - page 2
I hate home med lists. Hate, hate, hate them. They come up from the ER with no dosages, no routes, and no correct name. "Stool softener" is not an approved med name. The ER MD checks all the boxes to... Read More
Apr 9, '13The physician signing orders like that would not be acceptable in my hospital (meaning the hospital would be talking to him about it). I agree with the above reply; he ought to know what constitutes a valid medication order and what does not.
Apr 9, '13At my hospital, it is the ED nurse's responsibility to complete the med history before a patient goes up to the floor. Sometimes they are so busy they just forget. When I'm on the floor I politely remind them to finish it before the patient comes up, but also seeing how crazy the ED is at times, I know they just cannot get to that home med list. Gotta keep the meat moving as they say.
My absolute FAVORITE is getting the LOLs or LOMs from the nursing home with like 5 pages of meds.
Apr 9, '13Patients with a pcp In my area med records can be accessed by .my hospital same system makes it very easy and a pharmacist job. Howeaver ee are a third level hospital and take from the region but mostly pt are transferred from other hospitals and med rec is done. Big brother outstanding we have nhs (health insurance) numbers that I wish every px was reference but shouldn't usa social security number do the same
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Apr 9, '13I totally agree that the med rec is a problem. But, I don't expect the ER nurse to finish the med rec. They have so many other important things to attend to, and most of the time, the med list isn't really done until a family member can bring in a list from home the next day. If the med list is done before the pt arrives to the floor, I just see it as a cherry on top.
The problem I have is getting the primary to continue the home meds or simply address the admission med rec. Many times, I tell the doc to please fill it out and they don't do it. Half of the docs don't even write a SOAP note until the end of the day, so the med rec is a lost cause. Or, they just continue everything and it is my job to clarify that coumadin order for the pt with a massive head bleed (which is at the end of day when they end up writing orders from the office). Some write notes before they even round. I miss the days when a doc had to actually have the chart in their hand to write orders.
Pts should have a med list photocopied in the nightstand, and that should be handed to the medics when the ambulance gets there.
Apr 9, '13Med reconciliation is a GIGANTIC problem for us in home care. My Central Intake staff process 3000 referrals/month.
1/2 hospitials outside my health system and SNF's in my area send NO DISCHARGE SUMMARY /NO MED LIST. Physicians offices re even worse as all I get is a prescription form with "home care eval" listed + patients name: no date of birth, no diagnosis, no address/phone # or insurance info to locate patient!
1/3 patients don't have discharge summary that was sent home: "daughter has it", "at the pharmacy", "I left it at the hospital", or "I never got prescriptions" is what our admit RN hear all the time making it impossible to complete reconciliation on first, second and even third visit.
There is light at the end of the tunnel: 90% of the hospital referrals within my health system have discharge summary attached; physicians within my health system now have electronic EM; those that are Patient Centered Medical Homes do fax me a med list with referral demographics. Electronic Care Coordination Documents (CCD) efforts are underway nationally for interoperability-- expect this functioning within next 5 years.
The VA centers in Philadelphia area are excellent as will send discharge summary and current med list. Facilities using Curaspan E Discharge or Allscripts Care Managment electronic discharge planning web based software can include the discharge med list with referral--love these platforms.Last edit by NRSKarenRN on Apr 9, '13
Apr 9, '13I am just a nursing student but have a husband with multiple medical issues & on many meds. On more than a few occasions when he has been in the hospital... someone puts his meds in the computer incorrectly. For my husband, in an effort to make it easier on medical personnel, I printed a accurate list of all his meds on a fluorescent green 4x6 index card. One side has all meds, dosage and how often they are taken and the other side has all of his know medical issues. It also has his name, DOB and emergency contact info. We both carry one in our wallets and I keep the template on the computer. So when there is a change to the med list... it is easy to change it and print a new one. All that being said, nurses have still entered the wrong meds and/or wrong dosages. So even when patients come in with everything that you need for their med list... do not count on it being accurate unless you verified it yourself with the patient.
This has made me re-check patients home meds (if they know) while in the hospital.
Apr 10, '13Where I work the admitting physician/senior resident of whatever is responsible for entering all patient orders including the medications required during hospital stay prior to the patient leaving the ER. This system works well, the most responsible party reviews and prescribes the meds and it doesn't take up the time of the floor nurses or ER staff.
Apr 10, '13Wow. I can't imagine our pharmacist doing the med-rec list. Our any of our doctors. At my hospital, it is the nurse's responsibility, period. If the nurse can't get a correct list, the nurse gets written up. Or fired. They make a big, huge deal out of it. The nurses are supposed to make the patient's family bring in the bottles, but if they don't, then tough luck, it is the nurse's problem. We are in a rural area, and the pharmacies aren't open at night, or on Sundays, and some people get their meds from mail-order, so it is a time-consuming problem.
Apr 10, '13My ER is doing a pilot program where we have a pharmacy tech on the floor from 7a-7p to do home med lists. It can be a little helpful, but half my patients have no clue what the name of their meds are, or why they take them, let alone dosage. "Oh, I take that water pill, you know!" *headdesk* Nothing makes me happier than when a spouse or family member comes along and has a fully updated med list written out with all of the dosages and frequency. I don't trust nursing home lists though...too often I'll go over those with a pt only to discover they haven't taken the medication in months, drives me crazy.
Apr 10, '13At the hospital I work at, a Pharmacy tech comes to do a med rec. list from the patient (or family or from pills brought in) upon arrival to the floor. The MD/PA goes over it with the patient later.
Can't even tell you how much I love this system.
Apr 10, '13Quote from applewhiternBecause nurses are mind readers, and we should be able to just divine the list of home meds. Definitely should be a firing offense if we're unable to.Wow. I can't imagine our pharmacist doing the med-rec list. Our any of our doctors. At my hospital, it is the nurse's responsibility, period. If the nurse can't get a correct list, the nurse gets written up. Or fired. They make a big, huge deal out of it. The nurses are supposed to make the patient's family bring in the bottles, but if they don't, then tough luck, it is the nurse's problem. We are in a rural area, and the pharmacies aren't open at night, or on Sundays, and some people get their meds from mail-order, so it is a time-consuming problem.
But we're definitely more expendable than MDs and PharmDs, so we do make convenient fall guys.
Apr 10, '13another thing turfed off into nursing that imo should not be (at least not sole or primary) nursing responsibility
Apr 10, '13This is another case of "it falls to the nurses because nobody else wants to deal with it".
I do like hearing that some places are getting pharmacy involved.
I used to work in an area long ago where a some of the older people we worked with had limited levels of literacy. I remember being responsible for getting those long lists of home meds and once talking to a pt's illiterate next of kin on the phone out letter for letter everything that was on those prescription bottle labels. He couldn't really read, but he knew the alphabet. I left work really late that day.