General

Hospital Discharge: One of the Most Dangerous Periods for Patients

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10 Jul 2016 - General
 

Discharge from a hospital stay presents one of the most dangerous times for patients. Poor transitional care can be deadly, especially for patients with complex cases. Kaiser Health News recently published the results of its analysis of government inspection records related to patient discharge errors. This analysis revealed that, between January 2010 and July 2015, 3,016 home health agencies had insufficiently tracked or reviewed medications for new patients. Frequently, these home health providers failed to realize that their patients were taking dangerous drug combinations. Other medication mistakes were also prevalent. For example, one patient was given the deadly cancer drug methotrexate, instead of the diuretic metolazone, upon her discharge. She did not survive this mistake. Government inspectors noted that the most common issues among home health agencies were, in fact, failures in devising and implementing patient care plans. Failure to review medications was the second most prevalent error. Risk at the time of patient discharge may arise from the variety and number of different providers treating the patient, and errors can occur at any point during or after the discharge process. Federal data cited by Kaiser Health News found that fewer than half of discharged patients were confident in their understanding of their self-care instructions. A government report in 2013 also revealed that more than a third of nursing homes failed to properly assess patients’ needs, were unsuccessful in creating patient care plans, and did not follow these plans when they were put into place. Pharmacies, in turn, are an additional source for error, despite pharmacists taking a more active role in counseling patients and reviewing prescriptions. The number of providers, as well as episodic care provided to patients, can result in inadequate connection and communication failures between providers, as well as a lack of patient care coordination.

 

Pre-discharging is a process where medicines used in the ward are prepared in view of discharges (meaning patient takes them home). This helps reduces error as they get what they need. Drs often do not see what medicines the patient are taking, having a visual of the meds in front of them will help them realise that (and probably reduce polypharmacy because hey, that's quite a lot of pills there). A not truly tried method is pharmacist discharging where independent prescribing pharmacist pre...
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Double or triple check the prescription is a good practice to prevent prescriptions error. Agreed that pharmacy assisted prescription is an excellent strategy to prevent error in discharge prescription. Because of the traditional team structure in medical world, the most junior doctor will be subjecting to a lot of pressure, and error could happen, especially discharge prescription. I came across lot of stories that patients were sent home with prophylactic dose of low molecular weight heparin (...
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Prescriptions errors are deadly errors. I saw survey once that poorly written prescriptions is high leading cause of mortality. Though since this analysis was that of US patients it would be input errors as medications are now electronically ordered. The physician would type up the order and send the prescription to the pharmacy where the patient will pick up his or her medication. I was able to see about three interfaces like this. What I remember is that the physician selects drugs from drop d...
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For the last two comments made in this post, it is good to know that things were implemented in your area of practice to help prevent medication errors. But, I wanted to get some clarification from the original post regarding Methotrexate error. As healthcare professionals, we would normally discuss the medications with the patients prior to discharge, right? So, if Methotrexate was one of the medications that a patient has to take home, we would normally explain why he/she is taking it. I felt ...
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We try to decrease such error by having the pharmacist to go through all the discharge medication with the patient before they go home. They will usually be referred to a step down care general practitioner who has linked to the hospital medical information network. The patient will be review by this GP within a week of discharge. For the elderly without a reliable caregiver, we will also arrange a home visit by a social work with a nurse to ensure medication compliance and pick up any issues wi...
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Hi Vergilio, yes a lot of significant medical prescription errors can happen when prescription is given to patient upon discharge home from hospital. Usually, discharge summary and prescription of the patient will be done by mostly junior team members, usually the intern of particular medical teams. A lot of factors like time pressure, hectic work load, lack of understanding of patient’s management plain, careless mistake, or unclear length of usage of medication, and many more can result in me...
 (Total 115 words)