In a letter to the editors of the Journal of the American Geriatric Society, Dr. Amy Kind and colleagues explain how their pilot project to improve discharge communications inadvertently uncovered a flaw in the system that makes it easy for people who transport the elderly to make off with their opioid prescriptions.
They explain that commonly, a paper-based discharge packet is supposed to accompany patients from hospital to nursing homes. When the patient arrives without the necessary opioid prescription, the nursing home nurse may assume that the hospital forgot the prescription and order a new one.
Meanwhile, the hired driver, family member or clerk may be at the pharmacy, posing as a caregiver who is filling the prescription for the patient.
“Communication between hospital and nursing homes is routinely so hit and miss that nursing home nurses don’t think to report the prescription missing,” Kind says.
Kind, an assistant professor of medicine, is geriatric care researcher in the University of Wisconsin-Madison School of Medicine and Public Health. Her co-authors were registered nurse Laury Jensen and Dr. Korey Kennelty, a pharmacy researcher, all of them with the Geriatric Research Education and Clinical Center at the William S. Middleton Veterans Hospital.
Since most nursing homes lack the electronic medical records that link them to hospital orders, Kind and colleagues created a pilot plan to improve communication between hospital and nursing home.
A transitional care nurse calls the nursing home once the patient arrives, to go over the patient’s care plan and reconcile all medications.
In one case, this conversation uncovered the fact that an opioid prescription disappeared after it was handed, in the discharge packet, to the driver from a transport service. The police were alerted.
Most prescription drug monitoring programs do not track nursing home patients or the names of people who pick up their medications.
Eventually, universal electronic medical records will help. But in the meantime, Kind and colleagues suggest that hospitals create tamper-proof packaging for discharge order and prescriptions, and that they routinely track opioid prescriptions.
“We already know that fragmented care can harm patients,” says Kind, “but in this situation, poor communication between hospital and nursing home also hurts society at large by enabling opioid drug abuse.”
University of Wisconsin School of Medicine and Public Health