Home med lists make me crazy.

Nurses General Nursing

Published

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. :no: NONONONO What's the dose? How often? PO or SL?

Vit D daily :grumpy: 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.

Specializes in ER, ICU.

It's an opportunity! Work at the system level to correct the problem. Good luck!

The 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.

Specializes in ER, progressive care.

At 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. :banghead:

Patients 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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Specializes in ER trauma, ICU - trauma, neuro surgical.

I 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.

Specializes in Vents, Telemetry, Home Care, Home infusion.

Med 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.

I 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.

Specializes in Emergency.

Where 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.

Specializes in ICU.

Wow. I can't imagine our pharmacist doing the med-rec list. Our any of our doctors. At my hospital, it is the nurse's responsibility, period. If the nurse can't get a correct list, the nurse gets written up. Or fired. They make a big, huge deal out of it. The nurses are supposed to make the patient's family bring in the bottles, but if they don't, then tough luck, it is the nurse's problem. We are in a rural area, and the pharmacies aren't open at night, or on Sundays, and some people get their meds from mail-order, so it is a time-consuming problem.

Specializes in ED.

My ER is doing a pilot program where we have a pharmacy tech on the floor from 7a-7p to do home med lists. It can be a little helpful, but half my patients have no clue what the name of their meds are, or why they take them, let alone dosage. "Oh, I take that water pill, you know!" *headdesk* Nothing makes me happier than when a spouse or family member comes along and has a fully updated med list written out with all of the dosages and frequency. I don't trust nursing home lists though...too often I'll go over those with a pt only to discover they haven't taken the medication in months, drives me crazy.

At the hospital I work at, a Pharmacy tech comes to do a med rec. list from the patient (or family or from pills brought in) upon arrival to the floor. The MD/PA goes over it with the patient later.

Can't even tell you how much I love this system.

Wow. I can't imagine our pharmacist doing the med-rec list. Our any of our doctors. At my hospital, it is the nurse's responsibility, period. If the nurse can't get a correct list, the nurse gets written up. Or fired. They make a big, huge deal out of it. The nurses are supposed to make the patient's family bring in the bottles, but if they don't, then tough luck, it is the nurse's problem. We are in a rural area, and the pharmacies aren't open at night, or on Sundays, and some people get their meds from mail-order, so it is a time-consuming problem.

Because nurses are mind readers, and we should be able to just divine the list of home meds. Definitely should be a firing offense if we're unable to. :rolleyes:

But we're definitely more expendable than MDs and PharmDs, so we do make convenient fall guys.

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