Discharge Scripts

We have a very similar problem on the inpatient side at our hospital. It is the medicine reconciliation form that every inpatient gets when admitted to our hospital. There is an opportunity for the dr. to continue, d/c, or modify. They often will draw a big line through the entire “continue” column even though it is for “little blue pill” and dosing interval as “?”. I’m amazed that people will sign these things and then it become our job to sort out what the little blue pill is or why their inhaled steroid is considered a prn medication. They have become the bane of our existence. They would be a great tool if properly filled out. I guess a lot of it boils down to the patient not knowing what they are taking, how they are taking it, and why they are taking it.

I think your analysis of the sitation was correct-and he is a shit leader if he can’t accept the blame for one of his students-a manager always takes the blows, even if it wasn’t their fault. The asshole did realise he’d be held accountable.
Unfortunately for us in the UK, we don’get told when our patients are discharged…until they arrive expecting medication which I can’t provide by law because their GP has to see it first!!! At least yours are computer generated-the junior drs scrawls are bloody awful!!!

Agree both sides, heartily! These ‘tools’ are meant to provide some seamlessness from out-patient to in-patient between healthcare providers. Working both retail and hospital, it seems that if the only people that get upset with how the document pans out is the pharmacist. The ER nurse interviews t he patient, and ER doc signs it because he’s signing what the pt said s/he was taking, not that s/he’d resume the orders. The admitting nurse rewrites the orders based on admitting doc writing to resume home meds, so then when the pharmacist sees it and gets upset about duplication, polypharmacy, inadequate OTC info, under-, or overdosage, etc. (all the things we get hyper about) then is when things might get straightened out while in-house (while we’re juggling several other admission listomeds, plus whatever needs to get done while in-patient!). Unfortunately, by the time the patient is ready to discharge the document for resumption of take-home meds gets bungled and scrambled again.

I spent 3+ hours at the end of the shift while filling in at a Target store one weekend just trying to contact MD on call, admitting MD, pt’s own MD, rehab center where pt’s orders were from, and the pt’s daughter to find out whether or not the pt was to continue on the newly started anti-arrhythmia drug. Daughter is all upset because pt is out in the car, and she’s trying to get Mom’s prescriptions filled on the half-hour journey home. All I have to work with is a pt’s summary of discharge orders, with quizzical issue(s) of which drugs to fill based on checked boxes, and of course some of what has been written out in scripts is different from what’s on the discharge sheet. Of course the attending is gone for the weekend, and doc on call knows nothing, and pt’s own doc says he is scheduled to see the pt in a couple weeks and he didn’t put the pt on the drug. Finally, I was able to talk with the nurse that actually dismissed the pt when she left the rehab hospital. I wasn’t from the town, etc., but I think I talked to all the right people, aided invaluably by the tech crew that day.

I think that pharmacists need to get the info to start out with (needs to talk directly with the patient!!) , and also pharmacists need to produce or generate the info for the document to send on to the next pharmacist!

We are close to a hospital and get dicharge order all ALL the time. What makes me crazy is that this hospital has decided that they no longer need to print the dr’s name on the document. AND since this is a teaching hosptial, we can get everybody including the janitor writing prescriptions. I’ve come to the point where if I cannot determine the prescriber, its not valid. Go back and find out who discharged the patient, phone and dea number. Its not my job do to theirs anymore.

So WTF is up with Fentanyl AND naloxone?

It’s a set — you put in an IV opiate and they have the antagonist there in case the person gets too much or their respiratory rate drops. They put it in so it’s easy to get it out of pyxis and charge it if necessary.

Medication reconciliation recently a national patient safety goal of the Joint Commission. It makes me wonder if there is any way to better reconcile the facts about a patient’s medication profile than just by having a whole team of people review the profile with the patient. But, as I read this post, I began to wonder why we in pharmacy take the “Oh, so now it’s up to me to clean up this mess” attitude. We ought to wear it proudly. We ARE “the ones,” without whom there would be NO true reconciliation! TAP, it is your plain common sense, of not taking the dumb printout literally, that makes the difference here. Of COURSE the patient is not going home with a running IV of d5NS, or a fentanyl drip, or the narcotic antagonist orderthat goes with the fentanyl. We get to be the ones to chase down the various “officials” to actually establish the facts and dispense the proper medication. ONLY a pharmacist has his or hear heart on the drugs! It always seemed to me that other people (doctors, nurses, etc.) feel they can blow off the true responsibility, but we medication providers can’t do that, legally or ethically. Problem is, we don’t leverage our positions often enough by saying, when others get snippyabout it, “Hey, without me, none of this would get settled! Help me out here!

How do you know that the patient isn’t actually going home on IV hydration with a fentanyl PCA and Naloxone PRN? As one who provides this stuff in the home I can say that we don’t get all pissy about the various non-injectable meds on the patient’s discharge orders and figure that somebody on the retail side will be on top of that part of the spectrum. Ask the patient or caregiver: Are they on Home Infusion, Home Health, or Hospice services? It only takes a second……

I know this because I am in a retail pharmacy. I don’t have an IV Hood. I don’t have anything sterile in my entire pharmacy (with the exception of my urine).

PS - would you really expect a patient to administer themselves with PRN naloxone? Eat me…

HAHAHAHAH a home PCA. HAHAHAHA.

You’d have every crackhead in town lining up for a chance to “push the button”.

One of the hospitals around here doesn’t even take off the d/c’d orders. The patient will present the pharmacist with 5 pages of paper, and there will be maybe 2 or 3 prescriptions on it. Then we have to explain to the patient that we did in fact fill everything that the doctor wanted to continue (unless of course the doctor left the section completely blank, which means don’t fill, and he assumed we would just magically KNOW the patient was supposed to continue the med).