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Discussion

what is your take?

Pt came in to the emergency room and brought in their meds from home (gabapentin and lithium). Pt got admitted to unit. Pt is to get discharged and asks for their meds back (they were being discharged on these meds). Nurse calls pharmacy to see if unit/admitting nurse had sent them down to pharmacy-which is what usually happens. No record. Nurse calls ER--ER staff says if they have them, they'll call right back. Never called back. Pt is anxious to leave and doctor is calling in all their prescriptions anyway. A few days later, the medications mysteriously appear in the ER (astaff called pharm/the ER again just to make sure they hadn't been found)...Now my question is: what if the pt went to get their scripts filled and the pharmacy/ their insurance wouldn't allow due to their past prescriptions (of the drugs they were on and remained on at discharge) not being due to be refilled? The unit is going to mail the pt their meds back, but what about the interim of days until they get mailed (probably 3 days?) These pills aren't controlled substances.

Also, who would be at fault in this scenario? My quess is the ER as they should have sent the meds up with the pt as they are supposed to and didn't. They also didnt return call that meds were down there, even though they were.

Any thoughts appreciated.

Thanks!

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    In my mind, its no big deal. The provider just needs to ask for a prior authorization for the meds and the pt can get them.

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    In my mind, its no big deal. The provider just needs to ask for a prior authorization for the meds and the pt can get them.

    Only problem dealing with ins co...can take days to get straightened out...pt might be given opportunity to pay out of pocket, if new rx is called in. This, depending on meds could be costly The meds should have either been sent up with the pt, or held for them upon release.

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    being "down there" does not mean everyone who works there knew about them. Probably only one person was aware. Also, when working ER you have to prioritize - sick/hurt person vs. phone call. Sorry, but that is reality.

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    There needs to be a process in your facility for dealing with medications brought in by a patient and that process should be followed by everyone in every unit. At our facility we use a medication reconciliation form. It starts on every patient in the ED unless it is a major emergency situation. We list all the meds, doses etc., pharmacy if known. If this information comes from the patients list, we try to attach the list. If they bring the meds in, we list from the med bottles and then return the medications to a family member to take them home. If the patient is alone and there is no one to take the medications, the meds are send to the pharmacy for stroage until patient discharge. At discharge all medications are returned to the patient. We don't leave patients medications lying around. If by some chance they do come to our unit with their medications, we get them off the floor one way or the other as quickly as possible. We never allow patients to keep any medications in their room unless specifically ordered by the physician. And... if the patient just got the prescription filled their insurance will not pay for another refill until it is due, no matter what the circumstances. They need to have their meds returned to them.

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