Hospital Discharge Medication Error | Blog's Mission

In addition to the original mission, this blog will now serve as a companion blog of my website, http://www.competentdoctor.com/

The original mission is to tell real medical stories and inform visitors about medical errors and medical errors reduction strategies. This mission still stands.

One frequent medical or medication error at the time of a patient's discharge from a hospital's The Discharge Instructions about Medications.

Most patients before being admitted to a hospital are on several medications and most of them neglect to take the list or the actual medications to the hospital.

During the hospital stay, a patient's medications can be changed substantially.

At the time of discharge, most physicians in the past will write "continue all meds at home", although now most hospital rule will not allow this type of discharge order but it still happens due to certain hard-headedness, and "I am the boss" mentality of some physicians.

Recently a patient of mine, under the care of a a specialist in the hospital, was discharged home with very poor medications instructions. Please notice the instructions is in pleural.Actually there were 2 sets of instructions, one written with the list of medications taken during the hospital stay to be continued at home, and a verbal instruction from the nurse to to continue all the meds at home.

To make matters worse, the patient has Alzheimer's and the caregiver did not question the instructions. Also the caregiver did not call me immediately after discharge. This medications error was found out 7-10 days later at a follow-up visit in my office. By that time the patient was even more confused and could hardly stand up due to overdosage of a few medications. Luckily the patient survived.

The Discharge Medication Sheet must be the one and only instruction. It must list all the medications to be taken, including over the counter ones. The patient must also be informed to continue any medication that the patient was taking before admission.

The communications between the patient, the admitting physician, the nurse and the primary carep hysician, if he or she is not the admitting physician is very crucial to prevent this kind of mistake.

One more very effective measure: The patient or caregiver inform the primary care physician about the discharge medications immediately after discharge and ask which medications to take, to prevent duplication or discard of expensive medications the patient was taking before admission.

The primary care physician must respond to this request professionally and as soon as possible to prevent waste of medications and harm to patient. This is the safeguard to prevent medical errors committed by human almost daily in any hospital.

Medical Error | Prescription Drug Error | To Err Is Human

To err is human, but every effort must be made to reduce prescription drug error which is a common type of medical error.

There are many ways that a medication error can occur due to a prescription error.

Physician Errors:

1) Illegible handwriting causing a pharmacist to dispense the wrong drug, wrong strength of drug, wrong direction, wrong dosage or wrong quantity.

2) Legible handwriting but with wrong strength, wrong direction or wrong quantity.

3) Prescribing medication that patient is allergic to.

Pharmacist Errors:

1) Misread the name of the medication and therefore dispense the wrong medication without cross-checking with the prescribing physician.

2) Changing the strength of the medication without informing the prescribing physician and or the patient. Example: Hydrochlorthiazide(12.5 mg) was prescribed and the direction was for patient to take 1 tablet or 1 capsule a day. The pharmacist dispensed a 50 mg strength and the correct direction to take 1/2 of a tablet was printed correctly on the medication label. The patient who was so used to taking one tablet a day may or will continue to take 1 tablet a day, causing an inadvertent overdosing. This is quite a common error.

3) Guessing physician's handwriting which is illegible.

4) Do not crosscheck with physician about potential error committed by physician.

Patient Errors:

1) Do not read the direction on the label on the bottle of the medication especially when it is a refill.

2) Can not read the medication instruction due to poor eyesight or lack of proper education.

3) Unintentional over or under dosing due to forgetfulness.

4) Increasing or decreasing the dosage for whatever reason without telling the physician.

To Err Is Human! But every effort must be made to minimize prescription error. The physician, pharmacist and patient all play important roles in preventing this kind of error.

The followings are a few suggestions and should be a common practice.

1) The physician must write legibly. Writing the name of the medication in capital letters is a good idea. The strength, dosage and instruction of the medication must be accurate. When in doubt, consult the Physician Desk References(PDR) or other resource.

2) The pharmacist must verify with the ordering physician, if there is any doubt about all aspects of the accuracies of the prescription whether it's a written or a phone order.

3) The patient must read the prescription before leaving the office to spot any error and remind the physician to correct it, if any. If the prescribed medication is not familiar to you, feel free to ask whether you can be allergic to it, if you have history of allergic to certain medications.After the receipt of the prescribed medication from the pharmacist, the patient must read the all the information on the label on the bottle.

The subjects of ePrescription, high-risk medications, mail-order prescriptions and phone-order changes of medication dosage and or instruction deserve to be on another post.