In: Nursing
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.
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.