I'm disappointed that there seems to be such laxity with LTC. I understand that systems and situations as they are contribute to it, but it doesn't make it right or safe. Are there guidelines for LTC that give scope of standardized expectations for these items?
The medication time practices may align with what patients do at home anyway, but keeping things out/locked up til later/ etc just set you all up for errors. Especially the whole insulin thing...that's a high alert medication no matter what. Trying to educate patients and families on that with transition to home so I see this concern extending to the community. Can some sort of standardization occur with doc orders and patient schedules that make this doable and still safe? I can also see assessments more or less by exception (I would probably be doing a focused assessment based on PMHx or current status).
I recall doing home care on a patient that had crazy high sugars. A new regimen was started in the hospital, but it got lost in follow up and transition. She's having symptoms at home and she and her roommate just call them "spells" that pass and nothing is done about it. What is that? A potential 30 day readmission, cost, and negative outcomes for the patient. Also had a patient restart Coumadin and no follow up INR for three weeks when I went to visit. Really? All transition and communication issues.
I don't have insights on LTC and so cannot speak to what can be done to make this better. I believe all of you have the power to speak up and create a system, based on guidelines, that can be modified for your situation and safety needs. One size does not fit all...so how do you make it fit for your facility?
If regulatory demands haven't fallen on LTC yet (as much as the hospital), it will. It's just a matter of time and prioritization. This will sound corny, but you guys can change things and make a difference...I believe that. You're the experts in LTC.