Taking Call

[LuLu2008]

When taking call I received a message from a patient with an electronic medication planner. Her morning drugs had been dispensed in the evening in error. I was unable to reach her assigned nurse, so I went to the patient's home to check out the situation. The patient had 22 different medications taken in different combinations three times a day, with some dosages varying from day to day for Coumadin management. Some of the pill bottles were empty. Some of the labels on the medications no longer matched the so-called updated medication list. The medication list in the home did not reflect recent changes (and her nurse had been to the home today). Cups of medicine with lids were sittting around the table near the machine, no label as to what was in the cups. I was a little confused about all of this.

What would you do as the on call nurse?

Here is what I did, and I would like to know what your feedback is. I removed everything from the machine and put them in a bad with all the random cups of medication that were sitting out on the table. The patient has mental confusion and lives alone; I put that plastic bag aside so she would not take any of those medications by mistake. I then metered out the correct medications for the rest of today and the next three days and loaded the machine correctly. My plan is to contact the assigned nurse and tell her she needs to go back within the next 3 days to load the machine properly.

Please let me know your thoughts. The other option would have been to dissect each and every cup of pills, trying to figure out what was in them, and if it is correct, etc. Already I knew the machine had been loaded incorrectly so how am I to trust what is in the machine?

[annaedRN, RN]

Lulu- I would have done what you did - just get them through til the next scheduled visit. I have on occasion sorted out all the mismatched pills, discarding what could not be identified. That is a VERY time consuming visit. I often wonder how things turn out in the long run for these patients...usually once meds have been straightened out and machine is set up, teaching is complete...we have to discharge. I know sometimes family is very supportive, but other times.... office of aging did fund some programs for community programs for med prep, but that funding has been slashed. Anyway...enough rambling, I think you did the correct thing.

[caliotter3]

I'm concerned that the nurse was there that day and allowed this mess to happen. I doubt that everything was fouled up after her departure. How can you expect the situation to be correct from day to day when the nurse is not fixing things when she visits? What good is she accomplishing in her visits? Your supervisor might be concerned that the nurse is even visiting at all. It does happen that nurses do paperwork for visits that never occur. There is enough evidence here to make one suspect that this may be going on. If she is making the visits, then she needs to start doing her job, all of it.

[kids]

Oh I have no doubt it could have been messed up after the nurse left.

I have a client with dementia who fiddled with her med dispenser so much we had to lock it up and add the HHA obtaining her meds from the dispenser and handing them to her to the delegation.