Recently I received an after-hours call from a rehabilitation facility. One of my patients was recovering from surgery and they were out of one of her medications. Normally, a call like this would be a routine delivery and the story would end here. Instead, this call transformed in my latest adventure in Tales from the Counter.
The trouble began when the prescription was refilled: it was too early according to the plan. Either the patient had an additional supply, or something else changed. A call to the facility confirmed that the patient was now taking 2 tablets a day compared to the one tablet daily the written in the original prescription. As evidence, the facility pointed to the discharge summary the received from the hospital at the time the patient was admitted to their care.
At this point, I had to set my pharmacist hat aside and put on my detective hat. The job now is to track down who made the change, get an updated prescription, and then get a dose-change override from the plan. Not knowing where the change originated, I drafted and sent notes to three different physicians:
- The primary care provider
- The specialist for the medication
- The surgeon discharging the patient from the hospital to the rehabilitation facility
I was fortunate to get quick responses from all three. Incredibly, none of the prescribers acknowledged making the change. The surgeon wanted nothing to do with the change, and the primary care provider deferred to the specialist, who indicated they did not make any changes.
So where did this change come from? It is likely that the change was made erroneously during the hospital admit process. Possible explanations might include the patient relaying incorrect information or the staff member erroneously transcribing the information. Perhaps the patient misunderstood something their specialist or primary care provider told them at a recent appointment and conveyed incorrect information that they understood to be true. There are numerous possibilities, but if this was the origin of the change, the admitting staff recording the medication history did not spend the time necessary to reconcile the profile.
We regularly receive requests from local hospitals for a copy of our patient’s med profile. Our clinical software make is easy to create a list and send it off. Likewise, we request the discharge summaries for our patients whenever available. These help us ensure we are aware of changes before they become an after-hours emergency.
This story happens far too often in today’s health care environment. There are too many silos, with different groups not taking the time to communicate efficiently. In some ways, the current laws regulating health care and privacy are a part of the problem, making providers reluctant to volunteer information to other providers. In other cases, it is politics and money.
In the end, though, it is the patient and their care that counts. Yes, it can be a chore to tie up the loose ends. It took the better part of 5 hours to resolve the problem above, but in the end the patient was returned to the correct dose and the best possible care was given. When opportunity calls, even late at night, be sure to make every encounter count!
