Home med lists make me crazy. - page 2
by imintrouble 6,082 Views | 46 Comments
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 continue, and I know he/she... Read More
- 2Apr 9, '13 by classicdame GuidePersonally I do not understand why it is the hospital's responsibility to reconcile home meds when we will not be following the patient. We have a program that links us to pharmacies so we can get "official" lists with all the correct info. HAHA. First, government pharmacies are excempt from compliance with this program, so we cannot find out what VA patients are taking. Second, patients who use a locally owned pharmacy (not a chain) may or may not participate. Names are spelled differently so we miss out on Jane who should be Janie. And, as all nurses can attest, what is prescribed is not necessarily what is being taken. So it is a massive waste of time to get anything near correct. I still think it should be the job of the attending physician.
In Sweden (where I get to stay in the summer thanks to my son living there), the system for pharmacies is nation-wide. So my RX can be refilled ANYWHERE in the country and the hospital has a reliable record (as far as I know). Of course Sweden is about the size of California, but I would think a good computer program should work regardless. Oh well.
- 2Apr 9, '13 by Aurora77It sounds like the onus should be on the ER doc to get the med list correct. Surely they were taught how to write orders correctly? Since nurses can't prescribe, why should it be your responsibility to make the doc do his or her job?
This is definitely a system failure. Our pharmacists verify meds and it is up to the admitting physician to order them. It shouldn't be the responsibility of the ER doc, but since your facility has determined it is, they should be the one responsible until the system can be corrected.
- 2Apr 9, '13 by VANurse2010The 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.
- 3Apr 9, '13 by turnforthenurseRNAt 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.
- 1Apr 9, '13 by ayla2004Patients 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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- 2Apr 9, '13 by hodgieRNI 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.
- 1Apr 9, '13 by NRSKarenRN AdminMed 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
- 5Apr 9, '13 by PalmHarborMomI 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.
- 2Apr 10, '13 by CodeteamBWhere 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.