when we discharge a patient, we have to print out the medicines from the computer. we get both a list of outpatient medicines (on one form) and inpatient medicines on another- then we just reconcile them. for instance, you can mark the "continue" box on the eye drops from home, but mark "discontinue" on the home bp meds that weren't working, and mark continue on the inpatient bp meds that are working.
That is how it should work and does in teaching hospitals.
Let me explain life in nonteaching hospitals.
Prior to JCAHO raising a stink about med recs, the MD admitting the patient was to assess what meds the patient was on, and write them all out and order them.
90% never did -they wrote "Continue home meds" with no clue what meds the patient was on. This was obvious to the nurse admitting a GI Bleed for FFP and vitamin K, and noting that the patient was on coumadin, ASA and prednisone. And the writing of CHM orders was not permitted anyway, so we had to call the MD, who was pissed and let us know that he was pissed and being required to review the meds, telling us to "use our judgement" - which is not permitted as nurses cannot "prescribe".
They also rarely addressed DC meds - if they did, it was merely the new prescriptions - never addressing the old. Necessitating multiple phone calls to the MD, many of whom, side stepped it, not wanting to deal with all the patients meds from different MDs.
Thus patients bounced back due to med issues. Or worse, suffered serious issues due to this.
Jcaho recognized it had a critical issue. Thus the regs on med recs at admission and DC. Nurses put in the meds and print a form, that MDs check the box and signoff on.
And it doesn't matter when the patient is admitted, if the MD "forgets" to check and sign (which they all KNOW that they have to do), the documentation nazi comes and harasses the nurse because s/he "let" this happen.
In addition, every night we carefully print out updated MR sheets and place them on the front of the orders, so that if the patient gets transferred/DC'd, all the MD has to do is check and sign.
Easy, right?????????????
THEN HOW COME THE VAST MAJORITY OF MDS LEAVE THEM BLANK, and make me phone/fax chase them across Palm Beach County, to do the darn things? It takes one minute to check and sign but they will not do it.
At any community facility - in my humble experience, at least 50%-75% of them are not filled out - despite being right where the DC order is written.
PS, in WPB area, many forget to write "DC patient", though they conveniently tell the patient that they are DC'd. It doesn't occur to them to tell the nurse.
