So Close to Freedom and in the Most Danger: Patients at Discharge
Discharge from the hospital should be a happy time for patients. Even if they need some ongoing care at home, leaving the hospital for the comfort of their own space is a cause for joy. Discharge errors, however, may mark this occasion. Indeed, these oversights may lead to serious consequences.
Joyce Oyler’s Story
Joyce Oyler was a heart patient from St. Joseph, Missouri. In less than two weeks from her discharge from the hospital, she developed sores in her mouth and her throat. Blood began to seep from her nose and bowels.
Her daughter, Kristin Sigg (an oncology nurse), had immediate suspicions about Joyce’s condition. She traced her mother’s symptoms to the medicines prescribed for her condition. One medicine, a key part of helping patients like Joyce retain fluids, was missing from her prescriptions. In its place was a different, toxic, medicine with a similar name. “… As soon as I saw that bottle, I knew she couldn’t come back from this,” Kristin stated. Medication errors like Joyce Oyler’s are one of the most common problems discharged patients face.
Medication Mistakes
The Federal Interagency Steering Committee for Adverse Drug Events investigated the number of medication errors for discharged patients between January 2010 and July 2015. The organization found that 3,016 home health agencies failed to manage medications properly for the patients they discharged from the hospital. Those 3,016 agencies accounted for nearly a quarter of the total number investigated.
In some cases, home health nurses failed to recognize or inform their patients that they were taking potentially dangerous combinations of drugs. Patients were risking abnormal heart rhythms, seizures, bleeding, kidney damage, and more by mixing these medications.
Medication Reconciliation
Some health care professionals and agencies have recognized the danger that medication errors pose to patients during the discharge process. These specialists state that a medication reconciliation, or a medication review, is critical to decreasing the likelihood of adverse medication reactions.
Medication reconciliation is the process of verifying the appropriateness of a patient’s medications at any point-of-care transition – when a patient enters a hospital, changes hospitals, leaves a hospital, etc. Going through the medication review process helps medical professionals catch potential medication errors, and it allows them to educate the patient and/or the caregiver(s) about the medications the doctor will prescribe.
Other Problematic Areas of Discharge
While many patients who suffer from improper discharge procedures do so because of medication mistakes, other issues can arise. These include:
- Improperly educating patients before discharge. Federal data shows that less than half of patients report feeling that they fully understand a doctor’s instructions regarding how to care for themselves after discharge.
- Nursing homes failing to perform proper case management. Some nursing homes are overworked and understaffed – and others can be lax in their duties. Either way, when patients’ cases are mismanaged, their needs often go unmet.
- Patients do not learn from pharmacist’s counsel. Even when pharmacists go beyond the brief overview of a medication they are required to give patients, patients can have medication errors then the take their prescribed medicines improperly.
- Home health agencies do not form proper care plans. From 2010 to 2015, 1,591 home health care agencies were found to have defects so substantial that the inspectors suggested removing them from the Medicare program if the problems were not remedied. The most common problem with these agencies was a failure to create and execute proper care plans for patients.
Just because doctors declare a patient well enough to leave the hospital does not mean that individual is out of danger. Many problems can arise during the discharge process – including prescription medication errors.