A specific patient encounter that I had while in clinical was a patient who lived quite a distance to MMC where he was hospitalized. He needed medical care for an exacerbation of his CHF, but the resources he had around him were not enough to provide the care he needed. They told him he needed to drive/be driven to the ED at MMC where they would provide him with what he needed. This man was elderly and so was his wife who drove him over an hour to the hospital to get the care he needed urgently. The medical center he initially went to did not consider that toll that a drive like that may have had on his wife or him, as well as the time it would take for them to get the hospital to get the care he needed. The patient had already waited some time before going to the initial site of care, and that additional drive could have been detrimental to his health if he needed emergency help.
While providing care, we did successfully rid him of most of the fluid he had accumulated prior to arriving at the hospital, as well as we got his SOB and exacerbated condition under control with a new medication regimen. Yes, this was good that his health was back under control, but now an elderly man who may have had the same medication for months to years already is having to learn new medications. This can be extremely confusing to someone who is older and may not learn as quickly. If a medication is taken too much, not enough, or even at the wrong time it can have adverse effects that then will result in a hospital admission. Also, if he is confused about stopping his old medications, he may be double dosing on certain types of medications that have been re-prescribed with new names. The doctors likely assumed that since he has been managing his medications for this long that he could just pick up on a new regimen but that is not guaranteed. That form of assumption can lead to a rapid deterioration in his health.
While caring for this patient, they were also preparing him for discharge the same day. It was determined his wife was picking him up and taking him home, but a drive like that can be a big toll on his wife all in one day and him. They told him to pick up his medications on the way out at the pharmacy and that he was all set to be on his way. My concern was how he would find the pharmacy if he had never been there before. Also, was he able to walk to the pharmacy himself while his wife waited in the car? For someone who is young and health with no limits to their ROM or ability to walk it would be easy to walk around until you find the pharmacy, but he was older with some generalized weakness. What if he got tired while walking to find the pharmacy and had a fall? It was assumed that he would be able to find his medication and be on his way, but with no proper instruction or guidance that could be extremely difficult.
Overall, I think the health care system and workers can do better. There should be systems in place to deliver medications to the bedside upon discharge so that patients do not have to search for the pharmacy downstairs. Also, someone should check in a few days after discharge, even if it’s just a phone call, to make sure the patient understands their medication regimen still and that they feel the medication is working as it should. Patients should have to wait for a meeting with their PCP to confirm the effectiveness and understanding of their medications. The staff did a good job of explain the medications which plays a huge role in patient understanding, but without the medications right in front of the patient they may be confused of the shape or color of the medication they should be taking. Before this experience I knew the healthcare system could do better, but I didn’t really know how. Now I can identify some reasons; better medication education, more resources closer to vulnerable populations, better transportation for patients who are referred to bigger hospitals, etc. There is so much that the healthcare system can improve on, but with advocates within the hospital change will not happen. The nurses and doctors need to advocate for more for their patients so that better outcomes are seen.
