Recently, I read an article about a patient, after a surgical visit to a hospital, was discharged and told to resume her current medications. About a week later she presented to her doctor with partial paralysis, disorientation and extremely low blood sugar. She was intravenously given a glucose solution to immediately raise her sugar back to acceptable levels.
The doctor asked what medications she was taking and found that there were two that lowered her sugar. With the weight loss from her surgery and lack of appetite, her sugar was lower than normal so the additional medication was forcing the sugar levels too low. He recommended that she eliminate one of the drugs and sent her home.
Two days later he was called to the ER where he found the patient seizing. Again, her blood sugar was dangerously low. She was again given the intravenous glucose. This time the doctor asked to see the pill bottles of everything she was taking. It was only then that he found out that both drugs were combined in one pill. It was impossible for the woman to follow his instructions. This error, though not fatal in this instance, is repeated daily across this country.
Now the call has gone out for Discharge Summaries to have access to pharmacy information to take such decisions out of the hands of patients. With the plethora of pharmacies and over the counter medications, it’s almost impossible to take this out of the hands of patients.
Another complication is the myriad systems out there; each vying for control of the marketplace. The business model they’re using says that if they exercise control by using proprietary systems then eventually the market will be forced to use them. By controlling the information that customers can access and that can access the system, they control the buying behavior of their customers. Let’s see, that worked so well for the Sony Betamax!
The bigger issue is that patients need to be involved. They need to understand what they’re being given and why. They need to understand the effects of each medication and possible side-effects. Most of all, they need to be aware of their bodies enough to understand when something isn’t right.
To get patients involved the discharge summary must be the starting point. That means that instead of medical transcription getting them back in 24 hours, as is the accepted standard in the industry now, they need to be gotten back within 4-6 hours. They need to include all information about medications that has been prescribed for the patient and potential interaction difficulties. They should be cautioned about what to watch for and potential early warning symptoms.
Then, it needs to be taken a step further. This is where the hospital/medical center’s marketing department comes into play. Each person should be contacted for follow-up after care that focuses on three things:
- Wound care
- Drug Interaction
- Follow up to understanding and implementing instructions.
Each person should leave the hospital with a customized plan designed to get them back to full health, or some semblance thereof. The follow-up treatment will be designed to ensure that patients are following instructions.
