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Summary Patient Care Interview With adverse drug reactions being under-reported nationwide, what are you doing to look at these, determine severity and how do you report?
Do you track drugs like Benadryl, Prednisone? Y How do you tie this together this with tracking? MD trends, med trends Do you track these with med errors? Separate, but can be tied together if necessary What if I (MD) walked in and ordered Vacomycin 5,000 mg stat for a patient, who would challenge that? Pharmacist, Nursing What if I still insisted on giving the drug? Nursing would not give drug, would contact manager, Chief of Staff Pharmacist would ask why to MD and discuss with MD What if I still insisted, would you call the Chief of Staff? Y What if someone inadvertently gave the med? Call MD first, notify nursing manager How would CNO handle? Use as a learning experience provided no real harm to pt. Pharmacy would contact the poison control center if necessary. Surveyor comment – As I walk around hospital, I see a lot of control of meds in hosp. Looks like control items are under double locks. Any place, other than OR, that you would waste meds? Units
Are you comfortable with this? Y – Narcotic sheets are seen daily. Do you have a PNT committee? Y – MPAC is equivalent Do you look at cost, efficacy criteria? Y What if you have a one time request? One time requests, we work with MD. If more often, we take to committee. How do you handle sample meds? The hospital doesn’t have sample meds. How about the OP clinics? Y – Samples are given out at the clinics Does MPAC review samples in the clinics? Does the responsibility of the samples rest primarily with the physician on site? Surveyor suggested we use the same criteria for clinics that we do the hospital with the pharmacist involved not in the day-to-day management, but as "uniform" care for every patient. Asked dietary - What quality control measures do you have in place to ensure if a patient is ordered a special diet they get it? MD order, tray prepared, labeled, taken to patient, production sheet identifies item, diet supervisor checks and in between meal preparation times will prepare. Who delivers trays? Med/Surg – dietary staff ICU – nursing staff Do you collect data related to quality control? Y Who has the responsibility for education of patient? Nursing primarily Do nurses know enough? Y – but will call upon dietary/pharmacy if necessary How do you know appropriateness/effectiveness of nutrition plan? Do you do reassessments of a triggered patient? Y What is the frequency? At least every 3rd day One dietician? Y – but TPN – pharmacy will do. We have a certified diet manager. This situation is not ideal but high risks are assessed more frequently. Are physio para/lab values used? Y Surveyor comment - Nutritional plan of care should have on it "what" and "when" when doing assessment.
Continuum of Care: How does the hospital identify, integrate and have overview of continuum of care? As we establish new services, we look at continuum of care.
How does the pharmacy handle patients who come in who are taking over-the-counter meds, herbal remedies, and dietary supplements? Does anyone look at these? Does your screening cover these? There have been no orders written here for herbs by our MD’s. Can I take my St. Johns Wort here? Is it written on assessment? What happens when a patient walks in with a bag of meds, some even mixed together in one bottle? MD should know what they are taking. Sometimes we even check with their local pharmacist. Pharmacy can identify drugs by appearance. We have lists with pictures. Can patients self-medicate? Y Can patients keep medications at bedside? Y Is nursing responsible for knowing if they are competent to self-medicate? Nursing records compliance. Who does the OR nursing assessment? RN in holding area and in room, total body assessment. When patient shows with no H & P, what do you do? Questioned the turnaround time for dictation especially on weekends and after hours. Are the after-hour services for dictation actually used? Y You do have a policy to identify surgical site? Y – identified in DSC, Holding Area and OR Surveyor suggested that when the patient goes to the OR, all parties involved (as a group) identify patient, procedure and site to avoid any errors. Surveyor commented on all of the good answers given by the group.
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