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.

Giving Sample Medication | A Source of Medical Error

Medication samples given to patients in medical offices is common thing in this country. This endeavor is very helpful to patients who do not have prescription coverage.

Medical errors can easily be committed in the process of giving patients drug samples. There are many areas that that mistakes can occur:

• The sample medication has already expired but it has not been discarded for whatever the reason.
• Wrong strength of the sample medication is given when it contains a combination of 2 medications.. For example, AtacandHCT(16/12.5) is ordered but the staff gives Atacand(16mg.) instead. AtacandHCT(16/12.5) contains 2 medications: Atacand (16 mg.) and hydrochlorthiazide (12.5 mg.)
• Wrong strength of the sample medication is given even when it is a single medication. For example, Atacand(32mg.) is ordered but the staff gives Atacand(16mg.) instead.
• The wrong sample medication is given to patient outright.
• The wrong quantity of sample medication is given. For example, the physicain orders 14 tablets to be given but the staff gives out 7 or 21.
• Staff gives out sample to patients without the physician's knowledge.
• Staff takes medication sample for personal use or to give it to others who is not patient of the particular office.

How do we prevent medical errors or potential errors mentioned above?

• Disciplinary action must be imposed on any staff who who commits any of the errors above. The severity of the disciplinary action will depend on the severity of the infraction or whether any harm has been done to the patient.
  
• The patient should be instructed to always read the information on the drug sample package and the written instruction of how to take that particular medication. If the patient notices any discrepancies, he or she will notify the office before taking that medication.

A policy must be instituted in any office to prevent the aforementioned medication errors or
potential errors.

In my office we have such a policy :

• Physician writes the sample medication order in the office chart,including the name of the medication;its strength and the dosage direction.
• The first office staff will take the order by doing the following steps:

1. Pull the sample medication from the storage .
2. Makes sure that the pulled medication is exactly the one that the doctor order.
3. Reminds the doctor if it seems that the doctor has ordered the wrong dose or wrong strength.
4. Writes the expiration date of the medication in the chart next to the doctor's order.
5. Writes her initial next to the order.
6. Writes the name, strength, dosage, and expiration date of the medication on a small paper called patient-instruction sheet.
7. Let a second staff verify and initial in the chart if if every thing is correct and put her initial next to that of the first staff.
8. Let the doctor double check everything before signing the patient-instruction sheet.
9. The first or second staff will then check the sample and direction one more time before giving the medication to the patient.
10. The medication and the patient instruction sheet is then put into a special bag
    which will have the same function as any prescription bottle. This staff will sign another initial on the chart right before giving the sample medication to the patient.
11. Instructs the patient to keep the sample medication and the instruction sheet together in the bag. One bag will contain one medication.

Penalty for staff who commits an error by not following the above drug-sample policy:

• Put on probationary status for 3 months. Possible dismissal if another similar error is committed during this probationary period.
• Outright dismissal if any staff takes drug sample for personal use without the doctor's permission.

This policy has been in effect for more than 20 years. Staffs comes and go due to different reasons but no one has been dismissed due to committing error by not following the policy carefully. There were a few incidents of probation. On paper, it looks cumbersome but it becomes second nature for my staff in a very short time, with good supervision for new satff.

In conclusion, this policy works.