Discharge From Inpatient Unit With NO Pain Meds???

[tencat]

I have been working hospice for 4 years, and I've only ever worked for one agency, so I don't know if this is normal or not.

A rival company has an inpatient unit, and they had a patient there from our town who had not yet signed up with our agency. Patient was there for pain management issues after a relatively new diagnosis of cancer. Pt family wanted patient back home with hospice, but rival company does not serve this area, so patient was referred to us.

All fine and dandy until patient comes home. Spent 7 days in inpatient unit with PICC line being titrated on Dilaudid (morphine allergy). Two days before discharge patient yanks his OWN PICC line (agitated) and goes on oral meds. Patient transported home, I get there as Ambulance is leaving, and first thing I notice is patient is REALLY agitated and moaning, take vitals and HR is 125. So I ask wife when his last dose of dilaudid was. She said it was right before he left the unit for the 2-hour ambulance ride. He has been on PRN breakthrough doses every 2 hours, so I ask wife if we can give him a dose. She says "Oh good. You brought it with you." "Noooo......don't you have some?" I ask. She gives me the blank look. So I ask her where the prescriptions are that he might have been discharged with. He was discharged without ANY medications and NO written prescriptions to fill any medications late on a Friday afternoon to a town with no 24-hour pharmacy.

We got it taken care of, but it took 4 hours of the day, a special favor from a pharmacist that knows the family (nothing illegal), and an annoyed physician to do it. (Dr. wasn't mad at me, thank goodness). Is it normal to discharge a patient from inpatient without pain medications or prescriptions for them? Hospitals do that to us sometimes, but I kind of expect better from HOSPICE.

[tewdles, RN]

Nope, not normal, just bad discharge planning and transfer of care.

[leslie :-D]

not normal at all.

they are either incredibly incompetent, or i'm wondering if it was done purposely...since you're the rival.

i know it sounds horrible, but so do they.

seriously, that's just inexcusable.

leslie

[SoCalRN1970]

NOT NORMAL. Poor communication on both parts for discharge planning. Being on the recieving end of such a patient, it is imperative to know what scripts have been written for pain coverage BEFORE the pateint is sent out.

Now that of course was not your fault, but rather both agencies in my humble opinion. I have had pateints transferred from outside hospices and you bet, before the amubulance leaves, I am on the phone asking about medications, coordination of care and getting meds to the patients home before they arrive.

it's imperative.

Dont' knock yourself over this, it's a learning experience. I have learned as a hospice RN that one must cover themselves and in this situation it falls upon both agencies. I'd ask who ever arranged on your end for patient admission, who did you speak to about medications and what the patient was currently on... and why weren't they ordered before the patient got home??

[tencat]

Thanks all. Just wanted to know if this was the norm. I admit I got a bit paranoid, too, and wondered if the other agency 'forgot' on purpose :) But I think it was a miscommunication thing. Everything was handled at the main office, then transferred 100 miles to our staff, and the meds got lost in the shuffle. Sometimes it's really inconvenient to be 100 miles away from the big town and office. This is the first time we'd had a patient from another agency, so I suppose we were both assuming that the other would get what was needed, and of course neither did!

[caliotter3]

I've been sent on my way with instructions to get OTC tylenol for pain, when tylenol was no way going to be sufficient for my pain. I have just thought that someone was being stingy with their script. In this case, I would assume someone just dropped the ball, not that they deliberately expected the patient to be without necessary meds. But the rivalry explanation works too.