Medication Errors May Be Common After Hospital Discharge
Posted by piggie4299
This is one of the largest challenges of my job. It can be so difficult to tell how much a person understands. People are so quick to nod their heads and tell you they get when they have no idea what you’re talking about. It doesn’t mean that they are stupid. It’s mostly because we tend to over saturate people with information and the fact that they have been in the hospital implies that something significant has recently happened to them. Neither makes for a great set up for learning new information.
Overall, 20% to 30% of prescriptions are never filled, and 50% are not continued as prescribed, according to the U.S. Centers for Disease Control and Prevention.
But there is no good way to tell the reasons for this. Are people not filling the meds because they cannot afford them? Or because they never wanted to take them in the first place? Or because they didn’t understand the instructions they were given? Data like this does imply that there is a break down in the communication between providers and patients, but it does not indicate to me that it is solely a teaching created problem.
When someone said they were taking a medication not on the list, or forgot to mention one that was on the list, it was counted as an error.
I wonder if they asked these patients if they had seen a doctor since they had been discharged. It is not uncommon for a primary care provider (PCP) to change meds that a patient was discharged with. After all, these doctors tend to know their patients better then a doctor in the hospital. A PCP has a long standing relationship with a patient while a hospital provider has known the patient for only a small snap shot of their health history. If their meds were changed by their PCP, they would not be making an error.
And 59% of patients had a misunderstanding of the purpose, dose or frequency of their medications.
For me, that is the most worrisome tid-bit in this. It indicates that there is a clear failure to provide effective teaching for our patients. Our patients should be given information in a way that is useful and meaningful to them. However, I have encountered a surprising number of people that don’t want to be taught. They want you to give them a list of things to do and they intend to blindly follow your instructions. But since they did not understand the reasoning behind that list of instructions, they often fail to adhere to their plan of care. But how can you make a person invest more into their own health?
Single people were almost 70% more likely than people who were married to make errors.
This suggests to me that there is a significant social factor in the compliance with a patient’s plan of care. Perhaps people who are married feel that they need to be more compliant because not doing so is distressing to their family. Maybe the younger and unmarried folks are still in the phase of believing that they are immune to death.
He favors the idea of a brief health literacy test that might identify patients most likely to have trouble following treatment instructions after discharge.
It seems to me that there is an assumption that the issue centers around education. I agree that education is essential and needs to be improved, but I don’t agree that it is the sole cause for the data that was collected in this small study. It is very difficult to sort out the “why” behind a list of numbers and it is all too easy to reach a conclusion too quickly and with out a full consideration of all possibilities.
Why are women more likely to comply with their treatment plan then men? I doubt that women are smarter or better students by default. So, why then are we seeing a gender difference?
I personally feel that there are complex social factors at work behind the generation of the numbers and until we delve deeper into the “why” we will continue to fail to reach our patients. Communication is at the heart of health care. Without it, nothing can be done consistently and accurately. Please, remember to talk to your doctor/patient (depending on which side of the desk you are sitting on). And really engage with people. Everyone is different. Struggle to find a way to spend the time to connect in a meaningful way.