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Holy Screw-Up, Batman... This Could Happen to You!

Bear in mind: An educated family caregiver and patient are appreciated by the vast majority of physicians. You have every right to drive the process that keeps your loved one safe and healthy! Help yourself. Help others.
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Let's call this an ALERT BLOG. One that could save a life!

"Am I A Health Advocate"? was the title of a previous blog I posted highlighting the responsibilities associated with being an effective health advocate for the loved one in your care. These responsibilities included:

• Familiarizing yourself with your loved one's current health condition
• Understanding your loved one's physical and emotional needs
• Ensuring the doctor's recommendations are being followed
• Reviewing the list of medications and possible side effects

Given what I just experienced, I now realize I left out two important responsibilities:

• Don't assume anything
• Ask health care professionals as many questions as necessary until you fully understand and are satisfied with the answers

I want to relay a personal story that recently occurred. You have heard me mention my mom, Vivian. Vivian is a young 87 years old and although she's in good physical shape, unfortunately, from time to time she experiences cognitive issues that are brought on by clinical anxiety. When this occurs, Vivian needs outside support to navigate through a normal day. As a result, my mom lives in an assisted-living complex. It is a beautiful facility with a full-time medical staff on premise, prepared meals and a host of activities for the residents. Naturally, all these services result in a fairly hefty monthly bill. On top of that, because Vivian takes quite a few medications, she (correctly) decided to pay an additional fee for a medication management service to ensure she takes her prescriptions as ordered by her physicians.

Two months ago, Vivian was experiencing one of these difficult periods and was hospitalized for several weeks in an effort to find the right combination of medications that could help her. Happily, when my mom was discharged from the hospital, she was feeling great and was eager to return home.

A couple of weeks later, my mom contracted a virus and ran a temperature high enough to result in a trip to the emergency room, where she was admitted, treated and discharged two days latter. Now, this is the important part: When Vivian was admitted, my sister spoke to the ER doctor, provided a list of medications and carefully reviewed mom's medical history, including all the details of her recent stay at another hospital. Consequently, the attending doctor had all the crucial information he needed regarding Vivian's recent medical history.

Three days after being discharged from the hospital, I visited my mom and noticed she was unusually tired. Initially, I chalked it up to an 87-year-old going through a difficult few days and I assumed she just needed time to acclimate. However, the level of her tiredness made me a little uncomfortable so I went to see the nurse. And, this was when I unearthed some startling news: There had been a major medication screw-up by the hospital and a complete lack of diligent follow-up care at the assisted living facility!

The assisted living nurse told me that my mom was now prescribed THREE Ativan a day, which was tantamount to a full-time tranquilizer regiment. The real kicker was that the medications she was prescribed during her extended hospital stay -- the medications that stabilized her anxiety and cognitive issues -- had been discontinued...cold turkey. ARE YOU KIDDING ME?!

I had three simple questions:

1. Who authorized these medication instructions?
2. Did the hospital review the medication changes at the time of discharge?
3. Why, especially given that my mom pays for medication management services, didn't anyone at the assisted living home review the medication instructions from her latest hospital discharge and why didn't they question this dramatic medication change, especially after a short two-day hospital stay?

I received three completely unacceptable answers:

1. The hospital admitted that someone did not transfer the complete provided medication sheet into her electronic medical record.
2. The medication changes were not discussed at the time of her discharge.
3. The assisted living facility said it was not responsible for reviewing medication lists from hospitals and then comparing them to prior medication lists.

All of the answers infuriated me, but I was particularly enraged by the assisted living facility's response, which I found to be incredibly irresponsible, especially considering my mom pays an incremental fee for medication management. Hey, news flash...forget corporate responsibility: what about the concept of providing "good ol' quality care?!"

I am raising this topic because medication errors are much more common than you might think, and as a family caregiver, you need to take charge of this process. Leah Binder's September 3, 2013 Forbes http://www.forbes.com article, The Shocking Truth About Medication Errors, estimates one million medication errors are made in hospitals resulting in 7,000 deaths per year.

Thankfully, taking charge of this medication process is not as daunting as it may sound. It's simply a matter of asking the right questions at the right time and ensuring the answers you receive are satisfactory.

I've outlined several steps to take to help avoid situations like the one Vivian experienced:

1. Always have two copies of your loved one's updated list of medications, including brand and generic name, dose strength, and the number and times of day the medication is taken.

2. If your loved one is admitted into a hospital, provide a copy of medication information to the admitting physician and ensure that the list is correctly inputted into their system (Don't worry about appearing difficult! You are doing your job). If you are not satisfied, do whatever is necessary to make certain that medications are inputted correctly.

3. At the time of hospital discharge, bring the same medication list you provided the hospital at the time your loved one was admitted and ask the hospital discharge representative to carefully review the medications the patient has been taking during the hospital stay, the prescriptions they will be leaving the hospital with, and any differences between the post-discharge medication list and the pre-admission medication list.

4. If there are any differences between those two lists, ask why these changes have been made and request that this information be inserted into the hospital discharge instructions.

5. If your loved one lives in an assisted living facility, review the hospital prescription list with the nursing staff and review any differences between their pre-existing and new lists. If there are differences, have the nursing staff call your loved one's primary care physician to review and approve any medication changes and adjustments that have taken place. (Remember: a primary care physician will call any of your loved one's medical specialists on their behalf. The primary care physician can be viewed as your medical team QB). Personally call the primary care physician to ensure that all medication issues are understood and addressed.

6. If your loved one lives on their own or with a family member, call your loved one's primary care physician to review changes and ensure all adjustments made in the hospital are understood and addressed.

Bear in mind: An educated family caregiver and patient are appreciated by the vast majority of physicians. You have every right to drive the process that keeps your loved one safe and healthy! Holy Absolutely, Batman!

Help yourself. Help others.