Do You Worry About Your Patients' Safety?

by Dawn C. Dexter

Ensuring medication safety while caring for acutely ill patients with multiple chronic conditions in our complex and rapid paced environment presents a challenge to all nurses. We must rely on every patient and family, to provide an accurate medical history and medication profile.

Patients who are unable to provide an accurate picture due to illness or memory deficits require a heightened level of vigilance regarding medication safety. Recently this situation happened to me. In a matter of a week, two of my patients came from home without their medication lists and were also unable to give an accurate medical history.

My second patient, Darren, came into the hospital without a medication list. All he knew was, “I take sixteen pills, I had two MI's, and I have a pacemaker.” Darren informed me that he tried to call his doctor's office in Davie. They were not returning his calls.

Darren was homeless but he had Medicaid and a primary doctor. The admitting doctor's note indicated that Darren did not know his medication profile and his medical history was unobtainable.

Darren had a card in his wallet with the primary doctor's name and number. I asked him to sign a release of information to send to the doctor.

After calling the office three times, I obtained the information that was needed to complete the medical history and medication reconciliation list. It turned out the patient had an extensive cardiac history.

Since admission, Darren was not prescribed any of the medications he was taking at home. In addition, Darren had a pacemaker that had not been checked because he had missed his most recent appointment. The admitting doctor was called and orders were obtained to transfer Darren to a telemetry unit and a cardiologist was consulted.

So the question is, “Do you worry about your patients' safety?” and “who is responsible for obtaining the patient's current medication list?” Whose job is it to find out the patient's history if the patient is unsure of any of their information? Is it the patient, the family, the admitting doctor, the social worker, the pharmacist's or the nurse's responsibility to find out the information?

I sought out the assistance of the social worker and the pharmacist but when no assistance was rendered I decided to take on the responsibility myself.

According to the Memorial Hospital Policy updated 10/08 and titled Medication Reconciliation for Continuum of Care (Inpatient) the RN is responsible for obtaining the recent home medication list when the patient is admitted to the hospital.

The nurse can ask the assistance of the pharmacist, patient or family. This process should be completed within forty-eight hours. You may ask family to bring in the patient's medication bottles to confirm the correct medication, dosage, route and frequency. If the RN is unable to get the information, then the physician needs to be notified of the inability to confirm the medications from home.

So to answer the question of responsibility, it is you, the nurse, who is responsible to get the proper information from the patient and family.

We as nurses have the responsibility to advocate for those who cannot or are unable to speak for themselves. It does take the extra few minutes to obtain the information the doctor will need so the patient will get the proper treatment.

Safety, coupled with advocacy, should always be our top priority. If it were your family member or friend, wouldn't you want their nurse to go one step further to obtain an accurate history?

If that means sending a release of information to a doctor's office or calling another country, just do it. This effort could potentially save a life or at the very least prevent harm or pain. Act on what you know and use your resources to help you obtain the information.

You can ask the pharmacist, social worker, doctor or clinical nurse manager/specialist for help. It could be a matter of life or death.

So now ask yourself, “How far would you go for patient safety?”

Dawn Dexter, RN, CMSRN  October 2013.

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