I read an interesting article describing research into medications prescribed for acute illness being continued unintentionally after discharge. Given how often the issue of polypharmacy and responsibility for safe administration of medications have been discussed in my career the paper did make me sit up and take notice.
Nurses are very much part of the whole discharge processes. We all know how frantic and often sudden a discharge can be. Many system pressures force discharge decisions and the scrabble for paperwork and letters for discharge are often hasty. Then I thought about it again. If a patient is being discharged and the current medications are then simply continued there must have been a time, in hospital, when medications for acute treatment should have ceased.
Unintentional continuation of acute medications was found to be far more likely where the patient was hospitalised for longer than 7 days. So to my mind there are two errors in such a scenario. During that hospitalisation there should have been a medication review as the patient’s status changed and on deciding the patient was well enough for discharge, another review.
True it is a medical officer responsibility but as nurses administer medications some awareness about medications at these two critical times might be anticipated. Where discharge occurs to another facility, again the medication orders would be known to the receiving nurse. I don’t hold with the notion of “not my problem, someone else is responsible” where patient safety is concerned.
We all work under pressure and we all can make mistakes. A system where we all look out for each other, keep an eye on the validity of the medications we administer, question medication orders not just for administration safety but the purpose of medications, could reduce the risks of unintentional continuation of acute medications.
The paper looked at classes of drugs and situations that tended to have significant risk factors. The population studied was more than one million over 66 year olds in Canada. Different classes of drugs were studied and as you would expect varied results for each class of acute medications were noted. From my point of view as an administrator of medication and a patient educator especially at discharge about medications knowing the risk areas rather than the specific drugs could be applied to my practice.
Emergency admissions, older patients and patients with comorbidities were the most at risk for unintentional continuation of acute medications. So it seems to me something to keep an eye on when working with these clients especially is judging when acute situation is resolved if I need to raise the matter of reviewing the patient medication order chart. Simple.