double dosing

[joli]

Yesterday, I overheard a doctor telling my boss that a former patient became critical after leaving our floor. The story was a cliche in reconciliation of medications prior to discharge. On our unit, just before discharge, we (the nurses) write down the medications on a sheet (including new prescriptions and what the patient was taking at home) and explain to the patient when to take his/her next dose and what each med is used for. Apparently, a nurse wrote down two meds from the same category (two beta blockers, for example). I don't know what the meds were, I don't know any details on who the patient was. But apparently the patient didn't know any better and started taking both meds from the same category, hence, double dosing. Now, my boss is investigating the case. I just PRAY that I wasn't the one who did it. Hopefully it was a "float" from a different floor.

In a case like this, who is at fault? Is the nurse entirely at fault? What about the doctor who writes new prescriptions and also writes "resume home meds"?

Or the outside pharmacy who fills these prescriptions?

[Mulan]

I don't know. Who came up with that idea in the first place? JCAHO?

Personally, I don't think nurses should have to be responsible for that. I do not prescribe medications so why should it be my responsibility to tell the patient what to take? Seems to me that should be in the doctor's ballpark, or how about the pharmacist doing this discharge teaching instead of nursing?

Someone ordered the two betablockers (or whatever) and did not d/c one of them. It was not a nurse who did that!

I would certainly be verbal about it if it were me.

As far as that policy, if that happened to me, I would, in the future, write out the list and then call the doctor and read all the meds to him and ask if that is what the patient is supposed to be on and I would write it as a telephone order. CYA.

Good luck.

[tvccrn, ASN, RN]

I don't know who would be considered responsible for this, but if it had been me, I would have questioned the need for two medications of the same class.

This is where we as nurses can use those 5 Rights of med administration to advocate for our patients. I would much rather take a lecture from a doctor about the reasoning for his decision than know a patient became critical because I didnt' want to ask the doctor a question.

In our facility, we now have a policy that the doctors HAVE to rewrite all prescriptions new on discharge. There is no.....resume home meds or resume pre-op meds. Everything is newly ordered.

tvccrn

[HappyNurse2005, RN]

We use the med reconciliation forms on admission-teh admitting nurse fills out a list of the pt's home meds, including dosage, frequency, etc. the doc then circles Y or N to indicate "continue on admission" and then, Y or N to indicate "Continue on discharge" and signs it, to make it very clear whether or not they intend for a pt to continue whatmeds. i like it a lot.

[debblynn13]

We use the med reconciliation sheets too. But that doesn't always help. I had a d/c last week that the doctor went through the sheets and circled all the current meds that he wanted to continue, then went to the home meds and just quickly circled all of them. As I was going through them I found several that the pt wasn't taking at the hospital or where the dosage had changed. I had to call two different doctors to get them all straightened out. So even with the doctors "supposedly" looking the sheets over and signing them, there are mistakes.:redlight:

Oh and they still try to write resume home meds, but we call them and have them verify over the phone or fax them to the office to have them verified. We have only been doing this for about 6 months so guess we have to give them awhile to relearn.

Debblynn

[zacarias, ASN, RN]

I really don't think the medication reconciliation forms are as useful as they should be. I think when a doctor discharges a patient, he/she should be the one to write the medications on the form. Why right them on an order sheet for the nurse or secretary to transcribe. Neither one of the latter has prescriptive authority and while a nurse may catch a potential medication problem, this does not mainly lie on him/her to do so.