I'm a nursing student set to graduate in 3 weeks. I've been having my preceptorship in the ED and today I received a call because a floor manager contacted my boss saying I updated a patient's med list to say they got double the dose of seroquel they were supposed to have while admitted (they only found this out because the patient's GP wondered why she was getting the double dose in the hospital).
I remember the patient but I do not remember updating this medication. I feel horrible and don't know what I could have done to fix the situation (that is the worst part). The patient is fine and my boss wasn't mad, but it is really making me question myself and the future.
Any advice for the future would be great because now I feel like I don't even want to mess with home med lists.
I hate them too. Many patient keep accurate lists in their wallets but a surprising amount don't know or don't care. Calling their pharmacy to verify can be problematic as well because quite a few people use mail order pharmacies and I've found them tough to deal with. Then you have the people who shop more than one pharmacy. Whoever said it can be a "cluster" is spot on.
Med recs are so difficult. No one ever has a list or their pill bottles. Patients and families always say "The clinic has a list." "It hasn't changed since the last time I was here." I don't have access to the clinic at 5 am and most of the time it has changed. Very frustrating and difficult to ensure correct doses in my opinion.
Nurses obtain the medication history, which is the list of prescribed, OTC, and herbal medications the patient is really taking at the time of the visit. This in itself isn't true reconciliation. Sometimes, this may involve entering "unknown white oval pill for blood pressure daily" on the list. I've also always made notes about non-compliance by listing prescribed medications the patient should be taking but admits he or she isn't, and the reason. (I don't know anyone who loves this process!)
True medication reconciliation is a provider's responsibility. This is because you, as a registered nurse without prescriptive authority, can't choose to continue, discontinue, adjust, or hold medications on the list. The provider should be reviewing the list for duplicates, outdated medications, unsafe combinations of medications, etc. before placing prescribing any new medications.
One of the hospitals I worked in had a hard stop built into Epic where ER patients couldn't be discharged until the provider had clicked that he/she had completed the med rec. You'd be amazed how many lists still had antibiotics from 3 years ago, duplicates, etc. Many providers treated it as a box to check, not an opportunity to promote safety and medication compliance.
With that said, if the patient in this scenario received the prescribed dose for the hospital stay, and that dose fell within a safe range, it's hard to think of it as a double dose. I would think of it more as a communication error than a med error from a nursing standpoint.
I admire your accountability and desire to learn from this situation!
Medication reconciliation is ultimately the providers responsibility, from both a regulatory and reimbursement standpoint. It is required that the provider confirm the medication reconciliation is correct prior to ordering any medications to be continued while an inpatient, many if not most providers fail to do that, but in the end it's on them, it was nice of you to try and help the provider though.
I'm surprised that they would let a student do med recon. We have to do med recon for new admits and that's what patients will get when they're at my facility, and even seasoned RNs get stuff mixed up all the time and patients are rarely reliable in my setting.
It's a total PIA...at times we have patients with 20+ meds and providers are too lazy to verify and re-check and just sign off on whatever we put down. I always make a note if there's any meds I'm not sure about and ask the prescriber to re-check.
So OP- I wouldn't worry about it at all. If you're ever asked to do it again, make sure you tell your instructor to double check everything.
I always found med reconciliations to be a complete PIA. Many patients don't even have any idea what they're actually taking ("I don't know; the wife takes care of that"; "I can't remember the name; all I know is it's the little white one".
It's a very time-consuming and often convoluted process. Which is why I'm saying don't beat yourself up too much. It's a good thing you're conscientious and take this seriously, but you can only do so much.
I totally agree. The only way I knew with the highest degree what they were taking is if I went to the home and pulled all their medications out and went through them with the patient one by one. Other than that, if you don't actually give them you can't be certain. The prescribers can't even be sure what they take and often it was me that told them what they were on.
One of the hospitals I worked in had a hard stop built into Epic where ER patients couldn't be discharged until the provider had clicked that he/she had completed the med rec. You'd be amazed how many lists still had antibiotics from 3 years ago, duplicates, etc. Many providers treated it as a box to check, not an opportunity to promote safety and medication compliance.
Yes, because that is a perfect example of the difference between what is demanded and what is actually wanted (also demanded). What is actually wanted is for providers to move patients through the ED as fast as humanly possible.
At my facility, we are able to look at prescriptions filled at outside pharmacies with patient consent. It makes things so much easier when doing med recs!
dennis8, ADN, BSN, CNA, RN
68 Posts
I hate doing med recs.
"Uh, I take two of the pink round pills in the morning and 4 red square pills at night".