A physician asked me a question regarding what should be the role of hospitalists in carrying out discharge orders written by other physicians.
I have been following your blog since I was a resident and recommend it to a lot of people. Thank you so much for enlightening me on so many day to day hospital issues. I wanted to know your opinion about something that puzzles me. When a specialist changes a medication or requires a lab to be done as outpatient after a discharge order is written (for example you write: okay to D/C if okay with cardiology, and they change a dose or request stress test out-pt) who is required to write the new scripts and arrange that test? Is it the hospitalist’s responsibility to do it? Or is the specialist who changed the dose after you rounded required to handle it? It was easier during residency due to abundance of residents/fellows and the fact it was electronic RX access. What are your thoughts? As so far I always return back and make the adjustments needed for the patient welfare, and the fact I don’t know whether I should take stance and request that physician to do their job.
Dear physician, there is nothing puzzling here. It’s black and white. Read more »
When people talk about prescription medications, everyone is familiar with the concept of side effects from medication. But, did you know that there are things in your diet that may interfere with your prescription medication?
In addition, your prescription medication may interfere with over the counter medications. In this video, there are two interviews recorded on Wednesday, June 8, 2011 on local TV news. If you find the information above helpful, I invite you to check out other TV interviews on medical/health issues at MikeSevilla.TV
Lots of smart people over the years have been trying to figure out why people stop taking their medications within the first 12 months. Within the first 12-months of starting a new prescription, patient compliance rates drop to less than 50%. This rate is even lower for people with multiple chronic conditions taking one or more prescription medications.
If these medications are so important to patients, why do they just stop taking them? It defies common sense. Sure issues like medication cost, forgetfulness, lack of symptoms, and psychosocial issues like depression play a role in patient non-compliance. But there also something else going on…or in this case not going on.
The problem is that doctors and patients simply don’t talk much about new medications once prescribed. Here’s what I mean. Let’s say that at a routine check-up a physician tells a patient that he/she wants to put them on a medication to help them control their cholesterol. The doctor spends about 50 seconds telling the patient about the medication. The patient nods their head takes the prescription and boom…the visit is over. Read more »
*This blog post was originally published at Mind The Gap*
For those of us with geeky interest in health and medicine statistics, graphs, and charts, the Health, United States, 2010 report from the National Center for Health Statistics is that kind of treat. The 41 charts and graphs and 148 trend tables in the 2010 report (it’s dated 2010 but was released earlier this year) could keep me happily occupied for hours.
One graph that really caught my eye shows the percentage of Americans that take a statin. Statins are prescribed mainly to lower “bad” LDL cholesterol, but they may have other benefits, too. The statins include atorvastatin (sold as Lipitor), rosuvastatin (sold as Crestor), and simvastatin (sold as Zocor but also available as a generic ).
Here is the graph I am talking about:
Many Americans take statins. No surprise there. But half of men, ages to 65 to 74, and 39% of women, ages 75 and older—that’s pretty stunning. Read more »
Imagine your mother telling you she’s starting a new pain medicine, only to learn that she ended her life three days later due to a medication error. That’s exactly what happened to Linda Sanders, a 62 year old woman who thought she was getting the pain reliever Lyrica, but she accidently got Lamictal, an antiseizure medication. The mistake was probably caused by the similarity in the two medications names. Unfortunately, suicide is a known risk associated with Lamictal therapy.
Medication mistakes involving pain-relievers have consequences that range from inconvenient to potentially deadly. Why are errors fairly common and potentially serious with this group of medications? There are an estimated 75 million Americans who suffer with chronic pain, which results in a lot of prescriptions being written and filled for pain relievers. Also, people can react differently to specific pain medications. In fact, taking the wrong medication can make an unrelated medical condition worse, or even be fatal!
A large new research study recently analyzed over 2,000 prescribingerrors involving pain medicationsthat were caught before being given to patients that occurred at a teaching hospital. The errors ranged from doctors ordering the wrong dose of the medication or giving incorrect directions to the patients, to prescribing a medication inappropriate for a patient (patient allergic to medication). Most troubling was the fact that pain medicines with names that “look alike” or “sound alike”were also a cause of prescribing errors.
Medications whose names look similarwhen written or sound like other medication names have long been identified as a source of medication errors. The Institute for Safe Medication Practices (ISMP) even publishes a list of “Confused Drug Names.” Doctors aren’t the only ones who make medication errors because of confusing drug names. Pharmacists can accidently dispense the wrong medication, nurses can administer a drug with a similar sounding- or looking-name and patients frequently take wrong medications due to this confusion!
Looking at the list of confused drug names provided by ISMP, we see several pain medications on the list. Here’s a partial listing:
• CeleBREX (a nonsteroidal anti-inflammatory pain medication),CeleXA (an antidepressant) and Cerebyx (an antiseizure medication)
• Codeine (an opioid) and Lodine (a nonsteroidal anti-inflammatory pain medication)
• Hydromorphone (an opioid) and morphine (a different opioid)
• Lyrica (a medication for nerve-damage pain) and Lopressor (a blood pressure medication)
• Methadone (an opioid) and methylphenidate (a stimulant medication)
• Tramadol (an opioid) and trazodone (an antidepressant medication)
What can you do to minimize your risk of a medication misadventure caused by medications whose names look or sound like other medications? Here are some tips that may help:
• Ask questions. Doctors, pharmacists and nurses can make mistakes and you shouldn’t be afraid to question them.It’s your health.
• Use your health care team! Make sure your doctor and pharmacist provide important information about ALL of your medications before you leave the office or pharmacy.
• The National Council on Patient Information and Education (NCPIE) has a terrific handout of “Helpful Steps to Avoid Medication Errors” that you can print out and take with you when you visit your doctor or pharmacist.
• Make sure your doctor and/or pharmacist cover all the following points for each of your medications (and take notes for later):
o What is the name of the medicine and what is it for? Is this the brand or generic name?
o How and when do I take it – and for how long?
o What side effects should I expect, and what should I do about them?
o Should I take this medicine on an empty stomach? With food? Is it safe to drink alcohol with this medicine?
o If it’s a once-a-day dose, is it best to take it in the morning or evening?
o What foods, drinks or activities should I avoid while taking this medicine?
o Will this medicine work safely with any other medicines I am taking?
o When should I expect the medicine to begin to work, and how will I know if it is working?
o Are there any tests required with this medicine (for example, to check liver or kidney function)?
o How should I store this medicine?
o Is there any written information available about the medicine? Is it available in large print or a language other than English?
To quote the National Council on Patient Information and Education – “Educate Before you Medicate!” And if you have ANY lingering questions about your medications, call your pharmacist. It’s part of a pharmacist’sjob to answer patient questions, and it’s your health on the line!
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