Monday, September 13, 2010

Same As It Ever Was

This customer comes up to the counter to collect a Z-pack and some codeine-containing cough syrup for what appears to be a respiratory ailment. He seems thoroughly pissed off and grumbles to me, "Why do I get this every month? Why is it when I ask the doctor why I keep getting this, he just says 'I dunno'??"

Well, sir (ran my inner monologue) it might be related to your being about 150 pounds overweight. I don't sense a lot of physical activity here. I sense a general state of unhealthiness exacerbated by a lack of some good air moving in and out of those lungs on a regular basis --- like the ol' cough-and-deep-breathe they make you do in the hospital when you're bedridden so you don't get pneumonia and things like that.

But boy, was he mad at that doctor.

My second thought today has to do with the dreaded Hospital/Nursing Home/Rehab Center DISCHARGE. No pharmacy wants to see this horrendous fax coming because it usually means mass confusion, multiple questions and unanswered phone calls, a long, long list of medications both new and old that need to be filled and a thoroughly hysterical patient or family who don't know what the hell is going on (and are completely OUT of medication). I'm sure there are many places that try to do their best in sending the patient out the door with a clear set of instructions. Most of the time, it doesn't seem to work very well. The medications have usually been copied down by someone who doesn't know what they are writing. Most of the stuff wasn't even meant to be continued after discharge. Doses or medications have been changed from what the person is used to taking, and they don't know why. Some people get really upset by this and when they are elderly or confused to begin with, it's never good.

The companies that provide pharmacy services to long-term care facilities, as well as every hospital pharmacy, should have a Discharge Specialist. Some hospital pharmacists do discharge counseling on a regular basis --- that's good. They sit down with the patient or family, go through that list of medications, weed out the unnecessary stuff and clearly show them THIS is what you were taking before, and THIS is what you're going to start taking NOW.
They also set up a mechanism for them to get those medications filled and deal with the 'refill too soon' because the nursing home has already billed for them. Wouldn't that be great??


The Redheaded Pharmacist said...

I think that "general state of unhealthiness" you speak of is a great summary of the American way of life unfortunately. And have you noticed how those discharge faxes come at the worst possible times to try and call to clarify the inevitable mistake/omission? I think everyone being discharged from any kind of inpatient medical facility should get counseling/instructions on any medications that patient is going home with especially if they are new medications.

Cinnamon said...

I don't agree about the 'discharge specialist' because it would be someone's cushy job description, for someone that would different again than the primary provider or the person that actually gave some degree of care while 'in-house' and not know jack. Instead, I'm a strong advocate for a universal 'form' generated from the same source somewhere, e.g. the pharmacy dept.,the discharging MD, or the discharge nurse, WHEREVER, but a universal format. It's the dickens to look twenty different individualized forms from every little podunk or major various clinics, hospitals, urgent cares, nursing homes, rehab facilities, and have to try to figure out if a. the drug is to continue, and for how long, b. whether the drug was a formulary item, and whether the patient can go back to what they had before prescribed by the primary, c. try to figure out just exactly WHO wrote the order so we can contact them when the dose is wrong or something vital left out or duplications present--remember the doc working in the VA doesn't even have to have a license in the state, d. controlled drugs have to be written out on a special form in my state, and if the doc didn't write it, we ain't going to fill a script off a discharge sheet, e. and so on. I would also like to see an admission sheet coming from a pharmacy that we wouldn't have to figure out what the patient can recall. Could we ask for patient files available universally? Heck, when I find out a patient gets mailout scripts I know we'll be starting from scratch because mailouts are run by techs with no authority to say anything except 'no' you can't have the information because of HIPAA (which is totally WRONG, of course.

Canada Pharmacy said...

Many things happen in life and they ever seem to be like same thing is happening again and again. So that is not new.

Anonymous said...

Uh, no...I'm busy dosing and preparing the Xigris for a septic patient who's threatening to also bleed out...but hey, now that there's no injectable diuretics, pressors, antibiotics or sedatives available from Hospira, Teva, Baxter,etc there'll be more time to remind physicians what they prescribed.

Eileen said...

Though there might be a question of "was the last infection properly cleared?" if it reappeared at a clinical level after 4-6 weeks. And repeating the zpack would just compound the problem as the bugs are getting mightily used to that antibiotic.
Just a thought.

Stitch said...

I know I'm late in this conversation but there are multiple true medical problems that can lead to obesity and immune system dysfunction. In my case, Cushing's Disease.

It's so easy to blame people that are overweight for their health problems. For those of us that have true medical problems it's a never ending source of frustration. Take a moment to consider that you might be missing part of the picture before you judge.

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