Question

In: Nursing

A 49 year old female with history of Type 1 Diabetes Mellitus, kidney transplant and recent...

A 49 year old female with history of Type 1 Diabetes Mellitus, kidney transplant and recent diagnosis of breast cancer with spinal metastatic disease. She was discharged home on 9/3. On 9/6 she presented to a different healthcare facility with fevers and was transferred to the primary healthcare facility on 9/8. Records from secondary facility stated that the patient had a low-grade fever and blood cultures were positive for gram positive cocci and gram negative rods. Transfer medications of note, included Vancomycin and Gentamicin. Upon arrival the patient was afebrile. The physician reviewed the records sent with the patient but did not note the gram negative blood cultures in the history and physical and did not continue the gram negative antibiotic coverage. The hospitalization was prolonged and required surgical intervention due to the infection at the previous surgical site. Critical thinking: 1.) Would medication reconciliation have avoided this error from occurring? If so, how? 2.) Who do you feel are expected to reconcile medications for external transfer patients at a healthcare facility? Support your answer with facts.

Solutions

Expert Solution

Critical Thinking:

1.) Medication reconciliation is an important element in the patient safety which prevents almost 30% of the patient harm. Medication reconciliation is the process of verifying and prescribing of accurate medication for the patient in order to the continuity of care in a right way during the admission, transfer, and discharge. The physician failed to notice the negative culture report and failed to prescribe the third generation of antibiotics such as cephalosporin or fluoroquinolone. In addition, the patient has undergone a kidney transplant and lack of appropriate antibiotic results in surgical site infection. If the physician has followed the medical reconciliation steps definitely the error can be avoided.

2.) Reconcile medication for external transfer patient will avoid errors and sentinel events. Medication reconciliation can be prevent prescribing errors in the transfer patients. The physician should review the patient medication history and reconcile the necessary medication as soon as possible. This will protect the physician from adverse drug events and the patients from the life-threatening situation. The list of preparing accurate medication using medication reconcile during external transfer will help in the continuity of care and better outcome of the patient.


Related Solutions

A 45-year-old female with a past medical history of Type II Diabetes Mellitus (last hemoglobin A1c...
A 45-year-old female with a past medical history of Type II Diabetes Mellitus (last hemoglobin A1c of 12, currently on intensive insulin therapy), tobacco abuse (approximately 2 packs/day for the last 15 years), and thyroid cancer (anaplastic carcinoma, status post total thyroidectomy) presents to her family nurse practitioner with complaints of a sore throat, cough productive of thick sputum which appears “green,” and subjective fevers and chills (though her temperature has never been above 98.5 degrees Fahrenheit). She states that...
Terri is old a 28-year-woman with a history of type 1 diabetes mellitus (TIDM), diagnosed when...
Terri is old a 28-year-woman with a history of type 1 diabetes mellitus (TIDM), diagnosed when she was 5 years old. She has been brought into the emergency department this morning by her partner, Greg, as she is lethargic and unable to make any sense. Greg reports she has been unwell with a flu-like illness for the past week with nausea and vomiting over the past 2 days. Terri had decided not to take her usual insulin dose last night...
Terri is a 28-year-old woman with a history of type 1 diabetes mellitus (TIDM), diagnosed when...
Terri is a 28-year-old woman with a history of type 1 diabetes mellitus (TIDM), diagnosed when she was 5 years old. She has been brought into the emergency department this morning by her partner, Greg, as she is lethargic and unable to make any sense. Greg reports she has been unwell with a flu-like illness for the past week with nausea and vomiting over the past 2 days. Terri had decided not to take her usual insulin dose last night...
A 66-year-old female patient with a past history of diabetes mellitus, hypertension, and vascular disease presented...
A 66-year-old female patient with a past history of diabetes mellitus, hypertension, and vascular disease presented to an internist complaining of a cough and wheezing. The patient had immigrated to the United States from Ecuador several years earlier, and she spoke mainly Spanish. She lived with her son, who had been in the U.S. longer, spoke English fairly well, and worked as a computer technician. The son had sometimes come to medical visits with the patient in the past, but...
Gerald Luna is a 45-year-old client with a 15-year history of type 2 diabetes mellitus and...
Gerald Luna is a 45-year-old client with a 15-year history of type 2 diabetes mellitus and a 30-year history of alcoholism. His blood glucose is not well controlled on an oral hypoglycemic agent, and he drinks one six-pack of beer per day. Gerald works at a casino as a slot machine repairman. His wife of 25 years, Andrea, is also employed by the casino in the accounting department. Gerald and Andrea live on a reservation near the casino in a...
LR is a 56-year old female who was diagnosed with Type 2 diabetes mellitus two years ago.
Diabetes Type 2LR is a 56-year old female who was diagnosed with Type 2 diabetes mellitus two years ago. Her initial treatment consisted of metformin 850 mg twice daily. At her last visit, her Hemoglobin A1C was 9.5%. Her physician is changing her treatment plan to add insulin glargine (Lantus) 20 units once a day.1. What is the onset, peak, and duration of insulin glargine?2. List the main teaching points the nurse would include when teaching LR about her new...
Q7. NV is a 45-year-old Caucasian female with a history of hypertension and type 2 diabetes,...
Q7. NV is a 45-year-old Caucasian female with a history of hypertension and type 2 diabetes, and elevated LDL. She is started on atorvastatin in an attempt to control her condition. She returns to her physician complaining of muscle weakness and pain. Her creatine kinase levels are tested and found to be high. a. What is the likely cause of her symptoms? b. What genetic test might be undertaken that could explain this reaction? c. Can the prescription continue to...
v Compare and contrast the nursing implications for diabetes mellitus type 1 and diabetes mellitus type...
v Compare and contrast the nursing implications for diabetes mellitus type 1 and diabetes mellitus type 2.
Jill Stevens is a 58 year old patient with type 1 diabetes mellitus. She was diagnosed...
Jill Stevens is a 58 year old patient with type 1 diabetes mellitus. She was diagnosed with diabetes in her 20s and has had difficulty controlling her blood sugar, particularly for the last 5 years due to issues with health insurance and other financial concerns, as well as lack of motivation. She currently presents with hypoalbuminemia, edema, and a distended abdomen. The physician diagnoses her with nephrotic syndrome. What is physiologically causing the stomach distention? What is the connection between...
FSR is an 81-year-old man (103.65kg, 66.5 in) with hypertension, diabetes mellitus, anemia, kidney failure and...
FSR is an 81-year-old man (103.65kg, 66.5 in) with hypertension, diabetes mellitus, anemia, kidney failure and gastroesophageal reflux. FSR uses Apixaban 5mg bid for DVT recurrence (2014, 2018). Other medicines include: Pantoprazole, Ferrous Sulfate, Insulin NPH, Lisinopril/HCTZ and Gabapentin. In November 2018, he was evaluated by his primary physician for a fungus on the right foot, classified as severe and refractory to topical antifungal treatment. She was consulted at the infectious clinic for the treatment of the fungus in view...
ADVERTISEMENT
ADVERTISEMENT
ADVERTISEMENT