Home med lists make me crazy.

[imintrouble, BSN, RN]

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 doesn't look at what they're checking. Once the ER MDsigns that form, I can't add or subtract any info even if I absolutely know for sure it's wrong.

The last list was an absolute nightmare. A whole page with every single med missing something.

Ativan prn. NONONONO What's the dose? How often? PO or SL?

Vit D daily Do you know how many different Vit Ds there are in your hospital formulary? Does the pt even know which Vit D it is?

"Stool softener" and that's all.

Ten meds all similar to the above, and the MD checks to continue.

I have to try and clarify it with the pt, and the pt doesn't know. Where I work, the ER MD's responsibililty with the home med list stops once the pt leaves that area. So at 0300 I have to decide whether to call the PCP, or just leave it for the day nurse who already thinks I dump on her.

No way am I calling an MD about a home med at 0300. If I leave it for someone else to clean up, and they don't, then it's back on me and it's incident report time.

The pharmacy bottles would be nice, but that rarely happens. I could just take the orders off the bottles, and double check with the pt. That's when they bring them. But OTC meds are a whole other animal.

The best case scenario is the pt can fill in all the blanks. But I still have to write clarification orders for those ten meds.

Two admits last night took me twice as long as necessary.

There has to be a better way.

[Medic2RN, BSN, RN, EMT-P]

I agree with you; there is a problem. It's a systems problem and needs to be addressed at a level higher than the nurse. I work in the ER and I try to get a compete medication list, but sometimes it's impossible. Patients either don't know their medications (I think it's a blue pill. I don't know why I take it - the doctor tells me I need it, etc.) I ask them what pharmacy they use and try to call them for a list. Sometimes people don't even know what pharmacy they go to. Sigh!

I would bring this problem to the attention of your nursing director to get it changed. It's a patient safety issue that needs to be resolved.

[brownbook]

I can only agree it is a mess. I can see the ER having trouble and can think of no easy solution.

I work in ambulatory surgery. We are talking basically healthy ambulatory patients who see their PCP, then their surgeon, then we call them a few days ahead for a quick phone nursing assessment. Yet still the day of surgery we get the same thing. Their PCP or surgeon doesn't even list their meds, the patient saya they will bring in a list and forget. Even when they do bring it in it is not unusual for it to have different meds from what their PCP and or surgeon had listed!

I had a patient whose surgeon had about 10 meds listed for her. She was actually only on 2 or 3. There were meds on there she had taken once and had been changed or for good reason not renewed. She said she was denied health insurance once because she was on such a lot of meds! And it took a lot of effort on her part to get it straightened out.

[noyesno, MSN, APRN, NP]

Sounds like a bad system.

At my hospital, they have a pharmacist down in the ED who takes a medication history. If the patient is a poor historian or reports something that seems off, they call the patient's pharmacy to clarify. By the time the patient gets up to the floor, their home medications are in the computer ready to be reconciled.

Works really well.

[SionainnRN]

In the er where I work it's up to the admitting md to get the med list as part of their h&p. when they come in we do our best but a lot of times the pt doesn't know, the pharmacist has gone home and all the pharmacies are closed.

[RLtinker, LPN]

Maybe you should wake up the DR. at 0300, then maybe they will start doing a complete med list.

[imintrouble, BSN, RN]

If the pt doesn't know dose or times taken, then just leave the med off the list. I can leave a note on the chart for the PCP to address the med in the AM.

Or their pharmacy can be called in the morning.

The ward clerk simply ignored the orders that were incomplete.

My position is you can't ignore them when a physician has signed them.

Doesn't matter if it makes no sense.

What is the policy where you work?

[dandk1997RN, MSN, RN]

Our system allows us to free text a med with unknown dosage or timing and then it is up to the doc to address it.

Got super lucky Monday when a pts PMD, who happens to be one of our hospitalists, did her med rec. in my eight hour shift, I had to give her 43 meds. The day nurse said she had 30+ meds during the 9am med pass. So glad the doc did the meds instead of making one of us!

[ayla2004, ASN, RN]

Med rec in the UK is for pharmacy unit nurses so glad. However if pt bring in a list or mess in boxes I will get them prescribed.

Sent from my GT-I9300 using allnurses.com

[Despareux]

Whatever happened to the electronic medical record system that was supposed to be able to go as far as crossing state boundaries for patients prescription information?

[classicdame, MSN, EdD]

Personally 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.

[Aurora77]

It 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.