Obtaining home med list

classicdame, MSN, EdD · Apr 20, 2011

We are going to electronic medical records in a few weeks, but for now we have a form to jot down the info and indicate from whom the info was received. The admitting MD must sign, indicating receipt of data. Frequently the information is incomplete, so the nurse or case manager may call the caretaker, spouse, etc with pt's permission. The remaining gaps have to be worked out between MD's. An imperfect system at best. I do not believe it is our job to police the patient to be sure they are telling us all the data asked for, but to make a real effort to prevent the patient from negative outcomes.

buenavidaRN · Apr 20, 2011

If the patient has the med bottles it is best, most of the time (even with AAOx4 pts) they can't remember dosages or things like that. It's no big deal, we just get the info and then send the bottles to the pharmacy, a note is placed in the chart so the staff remembers to get them out before discharge. It's ideal if a family member is available to take home the meds.

A lot of times the ED nurses are able to compile the med lists before the patient is even brought up. Sometimes the patients are really organized and carry around a written list of meds and dosages. You just do your best ... call the patient's pharmacy or PCP. It's worth it to get an accurate list together ...

cherrybreeze, ADN, RN · Apr 20, 2011

If the patient is unable to remember all of their meds and/or dosages, I will usually call the pharmacy they use. I also ask if there is more than one pharmacy that they fill prescriptions at. That is really the best we can do.

True, patients can not be truthful about what they take, but there is ONLY so much we can do to get that info. There isn't necessarily much to *gain* on their end FROM being untruthful....so, they would end up getting something they don't normally take for a few days? If the MD even restarts the home meds at all (granted, I work on a post op floor, so often meds are held post op if they had an abdominal surgery). Our surgeons don't send them home with new scripts for these meds when they leave, they would have to see their PCP for that on their own. They will send them home with an Rx for pain meds, and that's about it. Not a huge amount generally, either.

I honestly don't think there are that many people who would lie about their meds knowingly. There just isn't much incentive to do so, especially when the patient's stay is as short on average as you describe. :twocents:

loriangel14, RN · Apr 21, 2011

If the pt brings in their bottles, or has family bring them in we get the info off of them and then place them in a bag with the patient's name on it. We have a large drawer that we put them in.If we don't get the info about home meds we just chart the home meds as unknown.

LouisVRN, RN · Apr 21, 2011

I guess I'm just concerned as there have been two incidents in as many weeks. The first relatively minor, pt states he takes twice as much pain medication as he actually does, next day drowsy and when pt's asked in front of family pt agrees with dose originally stated, family disagrees and eventually pt "remembers" his doctor changed the dose. Second incident nurse wrote wrong medication on home med list (potentially life threatening) and medication was reordered. Pt received med multiple times a day and never to my knowledge questioned why he was on it and not on his actual home med (which he has been on for some time. Just makes me really think there has to be a better way.

sharpeimom · Apr 21, 2011

something my husband and i did several years ago has been helpful. i made a list for each of us that shows current meds, conditions being treated, diseases, birthdates, which i update every three months.

the master lists are in my draft file of my email account. there is a printout of each taped to the inside of the kitchen cabinet door by the sink, another set in the glove compartment of the car, and folded copies in each wallet.

the paramedics know about the ones in the kitchen and have taken the one needed with them when they transported. they become part of the er or floor chart record. our internist said he wishes more people would do it too.

LouisVRN, RN · Apr 21, 2011

Yeah people that bring lists are my favorites! I make sure all my family members have one, however the people who hand you a list and then begin to "correct" it not so much LOL.

GM2RN · Apr 21, 2011

In my ED, nurses are REQUIRED to enter home meds into the computer. When patients are admitted, the list is printed and the ED doc checks which ones to continue/discontinue, and it gets sent to the floor with the rest of the patient's paperwork.

Patients bring in med bottles, lists, or tell us from memory. If they can't do any of those, we have a family member get them to us ASAP and we document this. In theory, we could get a list from a physician or pharmacy if necessary, but since I work nights, that almost never works for me.

When patients are admitted and they have med bottles with them, the meds are given to the nurse on the floor they are admitted to for safekeeping when the patient goes to the floor.

BluegrassRN · Apr 21, 2011

The ED nurses enter the information, and they get it from the pt. Either the pt brings in the bottles or provides a list (either by rote or an actual list). When they are admitted, we on the floor confirm it with the pt. After we have gotten the info off the pill bottles, we give the pt the option of either sending the pill bottles to the pharmacy for safe keeping, or sending them home with a family member. They are not allowed to be kept at the bedside, for pt safety and because we don't want them to turn up lost.

For pts who don't know, who are confused, who have complicated med lists, or whose meds do not seem quite right (high doses of narcs, etc), the pharmacists confirm directly with the pt's pharmacy.

The ideal at our hospital is that the pharmacist goes over the home meds with every patient upon admission. This doesn't always happen, but it usually happens 95% of the time.