The Right Meds: How to Avoid Prescription Mistakes During Care Transitions

When your loved one is admitted to the hospital, whether for a planned procedure or an emergency, there’s no shortage of stress. Enduring tests, waiting for a diagnosis, managing pain, undergoing surgery, battling symptoms—there’s a lot to contend with, not to mention the team of unfamiliar health care professionals who seem to ask the same questions, over and over.

In the midst of all that commotion (don’t ever expect anyone to get a good night’s sleep in the hospital), one of the most important issues is often overlooked—whether the medications your loved one needed before admission are the same as the ones that he or she is receiving at the hospital and being given upon discharge.

Poor Communication Risks Serious Consequences

Sometimes the mix changes for a good reason. A new condition may require an adjustment of prescriptions. But all too often, a medication is added in, another subtracted, or a generic is substituted for a name brand, and the outcome destabilizes your loved one’s health.

Let’s say your 80-year-old mother needs a blood transfusion during hip surgery, after she’s fallen. She’s been on Lasix for years to treat her high blood pressure, but the transfusion requires a reduction in her diuretic. No one’s paying attention when she’s sent home, her orders don’t include restarting her Lasix, and she goes into congestive heart failure.

Or your 75-year-old father suffers a stroke. He’s sent from the hospital to a nursing home for rehab with sheets of prepackaged meds, including Coumadin, to lessen the risk of blood clotting, but no one noticed that he has a history of stomach ulcers. A few days after he enters rehab, he’s sent to the ER because he’s vomiting blood.

None of this is intentional. The problem is that important medical history, including an accurate list of medications, can get lost in the shuffle when you’re dealing with medical professionals who (a) don’t know the patient and (b) are under tremendous pressure to see as many patients as possible in any given day. The lack of consistent transitioning with medications gets even more complicated when your loved one goes from home to hospital to nursing home—the more changes of care setting, the more opportunities for mix-ups.

Five Steps to Minimize Chance of Medication Errors

Here are a few ways to minimize the risk of medication mistakes during transitions of care:

  1. Always have an up-to-date list of your loved one’s medications with you if he or she is admitted to the hospital. (Be sure you carry one for your own meds, as well, should you ever find yourself in the same circumstances.)
  2. Keep a notebook during your loved one’s hospital stay, tracking diagnoses, test results, any medication changes and why. Don’t rely on your memory. You’re under stress, as well, and it’s easy to forget details.
  3. Ask questions. Never hesitate to ask the hospitalist and other attending physicians about their reasons for making changes in medications, potential side effects and drug interactions.
  4. Review post-discharge medications with your loved one’s primary physician. Don’t take the discharge orders or any left-over packs of meds for granted. Be sure that someone who knows your loved one reviews all the orders. If your loved one has a visiting nurse for follow-up care at home, ask for a review of meds. Often, this is a visiting nurse’s first task during the initial intake visit; it’s called medication reconciliation.
  5. Whenever possible, use the same pharmacy to fill new prescriptions and refill old ones. This can get challenging if your loved one’s insurance changes and has new formulary requirements, but it always helps to have one source, with a pharmacist who knows your loved one’s medications and who can flag potential drug interactions.

Hospitals are busy places. Shifts change three times a day. The medical staff follow many complicated cases, giving priority to patients with life-threatening conditions. Unfortunately, it’s all too easy for the details of medications for chronic conditions to get overlooked during care transitions. Bottom line: If you or your loved one is very sick or in pain, always bring an advocate along—a family member, friend or Aging Life Care™ manager who really knows how to work the system—to be sure nothing is missed.

President of Deborah Fins Associates, PC, since 1995, Deborah Liss Fins is a licensed independent clinical social worker and certified Aging Life Care™ manager. Drawing on more than 30 years of professional experience in aging life care management, DFA offers comprehensive assessments and planning, guidance in selecting appropriate care, help identifying resources for financial support and professional consulting. Please contact us to set up a complimentary initial telephone consultation.

For more on coping with aging, follow us on Twitter: @DeborahFinsALCM.

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