Medication errors in the home registers as the one of the highest risk to patient safety in the UAE. According to recent admission data to Enayati Home Healthcare, approximately 50% of hospital discharges contain some form of discrepancy as defined by the Institute of Safety Medication Practices, ISMP Canada.
Often the ordering physician is unaware of treatments and medication regimens treated by other physicians. Discharge orders on the final day at hospitals are often left for the medical house officer on duty. Families will choose to ignore the team of doctors who have just treated a major stroke, and defer to their long standing Cardiologist of choice at another private hospital. We have seen patients being discharged home on a blood thinning agent while family is insisting to continue a previous prescribed anticoagulant (also blood thinning). The nursing team searches and tries to draw out the information delicately from all members of the care team.
The hospital discharge in all facilities at many times is rushed. Families have been given a tentative discharge date and time but all is dependent on the results of the morning blood draw. The ward or unit doctor reviews the lab results with the primary Consultant to get the final discharge clearance instructions. Within a 2 hour time frame the family will need to vacate the room, attend to the billing department, and wait for the medications from the pharmacy. There is little time spent on reviewing the medications, and if so, retention would be poor due to anxiety related to going home.
MEDICATION RECONCILIATION AT THE HOSPITAL
Reconciliation of medications prior to discharge from hospital will allow the opportunity for clarification with the hospital team. Common errors include discrepancy with the physician order and the pharmacy issue instruction; the physician order and what the verbal instructions given by the nurse, omitted instructions for medications taken prior to hospitalization. If asked, the homecare nurses will insist to visit the hospital on discharge day as part of its admission process at no extra cost. Spending 1 hour in the hospital can save numerous of hours spent on seeking clarification after hours.
It is important to ask the family “and why are you taking this medication for ?” as part of the medication reconciliation. Families have a rich and long health history of the patient. Their understanding of the medication will give insight to any existing gaps and or discrepancies which will require clarification. Sometimes all that is required is one phone call or visit to the doctor. The homecare nurse can gather the information and work to resolve discrepancies within the first 24 hours. Our homecare team will converse with the family drivers and cooks and other domestic staff that have a daily account of the medication routine. Remove the clock from the wall and ask the family cook to point to the time that the medication is normally given.
Medications at home is a high priority program for Enayati. Standardization of discharge medication procedures is urgently needed for all hospitals to follow to minimize variations in practice settings. Patients returning abroad from treatment bring a different medication regiment which families are insisting to follow. The reconciliation of these medications has proven to be difficult and a new challenge that falls outside the normal medication safety guidelines. Identifying for medication discrepancies include drug-drug interactions requires a systematic approach to program management.
Enayati Home Healthcare Center follows the Institute of Safety Medicine Practices ISMP Canada for medication safety. Being Accredited to Canadian Standards requires a diligent review of medications upon hospital discharges as well as on admission to the homecare service.