Tuesday, November 21, 2006

Medication Reconciliation An Example

The posting on medication reconciliation brought the following example from Jim Walworth; friend, former colleague, and retired CEO of Health Alliance Plan, the HMO of Henry Ford Health System in Detroit.

Your note on medication reconciliation brought back the memory of one of my mother's hospital discharges. She was a 92 year old, insulin dependent diabetic with long term congestive heart failure. Her hospitalization was to regain an appropriate fluid balance. On discharge by the consulting cardiologist, she (I) was given several prescriptions to get filled, each of which was for a different drug than she had been on at admission. The floor nurse pointedly said that the "doctor" wanted only these new prescriptions to be given my mother. I told her these were all the equivalent what she'd been on but I would, nevertheless, get them filled as soon as possible. I also told her that because there was no written prescription for insulin I would just keep her on the pre-hospitalization dosage. She rather adamently told me that "If the doctor wanted her on insulin he would have given you a prescription!" Fortunately, I knew enough that such a direction was clearly erroneous. While I knew that I would just keep her on the insulin, I couldn't resist asking for the nurse's name so, as I told her, I would know who to sue when my mother was readmitted through the ER in a coma.

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