How would you address this (hospital medical error, not legal advise)

During a recent overnight stay, I had one issue with the hospital (not performing monitoring that the surgeon had ordered). Wrote a nastygram to the hospital administration - the surgeon encouraged me to do this. That’s ready to go into the mail.

While an inpatient, I found the surgeon had written orders for my daily meds. Had I had a chance, I could have told him I had my own and this was not needed. As I had all of my own with me, and I think it’s silly to pay hospital markup for such things, I refused the meds. I had an inkling that one had been omitted that evening anyway, so it was just as well.

I got copies of my medical records and there were some pretty substantial errors in what was ordered (meds skipped, dosages doubled) - so it was really a good thing I had my own stuff.

I’m NOT planning on taking any legal action whatsoever. This is NOT a thread requesting legal advice.

However, I think it’s important to notify the doctor, at least, that these errors occurred. Were the meds in question different, or had I not been paying attention, things could have gone badly. Per my hospital records, they had a very clear list of the meds I currently take, so really there’s NO excuse for this.

I also wanted to let the doctor know of some information he wasn’t aware of (he ordered one anti-nausea med that would have caused very unpleasant side effects; this was not an error, just his lack of familiarity with a condition I have; I wound up not needing any such medication so it was moot, and it was my lack of specificity that led him to order the med anyway).

Now, part of my dilemma is the surgeon is very skilled, I had a perfect recovery, I don’t want to get him in trouble with hospital administration, etc. though maybe I should (report it to the hospital).

I’ve drafted a letter that essentially goes:
a) suggestion for something minor to improve patient comfort via discharge orders
b) mention of the anti-nausea medication for his info, including cite
c) oh, and you EFFED UP on the med orders and this is why I don’t trust hospitals, as I told you when we first met.

The plan is to send this to him, and a cc to my primary care doc.

Medical Dopers especially, Is this a reasonable plan?

Forgot to say: I recognize that sometimes there are medical issues at play which necessitate changes in one’s medication while an inpatient. As the need to stay had nothing to do with the surgery, but rather some post-anesthesia monitoring, and I believe the changes are NOT in line with that, I think it’s a screwup, rather than a medical decision.

I would send it.

I come equipped with a printed spreadsheet of my exact meds[specific brand name including the make and model number as it were, not just the generic name. it does make a difference if it is the regular or sow release form etc], the times I take them, exact dosage. I also have what procedures I have had, hospital i had them done and accurate date. I include my allergies and what the particular reaction happens to be. I also bring my meds =) no sense in paying for them when I have the specific ones I use.

I hold myself responsible for making sure I get my meds in a timely manner. I take a fair assortment of meds, and I am on a strict timetable, even to the extent of my alarm clock in my cell phone set for the times. I will not force a nurse to have to be in my room at exactly 5 am, 1 pm, 5 pm and 9 pm. They have other patients to deal with. I also do my own blood glucose monitoring.

You said the medication was skipped and the dosages changed, were the drugs themselves the exact same? Many hospitals will change a drug in a therapeutic class to another that they have on formulary. The drugs would do the same thing, and would be equivalent, but the doses and administration times might change (For example, Lipitor (Atorvastatin) 20mg at lunch might change to Zocor (Simvistatin) 40mg at bedtime). This would be normal for a stay in a hospital.

However, if the dosage was changed on the same drug, for no reason, that would be a bad mistake and should be reported.

There was one substitution (I take Prilosec, the doctor actually ordered that, but all the hospital has on hand is Protonix). Same class… though the dosage was ordered twice a day. I can’t necessarily quibble that as I don’t know what the comparisons are. Though I think it’s silly of them to not have both varieties - what if there were a genuine medical reason I couldn’t take the other one?

But… I take a beta blocker and an ACE inhibitor in the mornings. The beta blocker was omitted entirely, the ACE inhibitor was doubled (twice a day). As the ACE inhibitor was a recent addition and I’m not 100% sure it was helping, this seems… unwise.

Oh, and I should clarify, I don’t mean to actually say “you fucked up”… I’m capable of being somewhat more diplomatic than that!

The hospital I did a rotation at had this exact same therapeutic substitution on formulary. Omeprazole has a lot more drug-drug interactions then pantoprazole, so this is totally understandable.

Now this is bad. I can’t think of a reason they would omit a Beta-Blocker totally, and they shouldn’t just double a dose of an ACE-I, especially by giving twice instead of once a day, as long as it was the exact same one that is. These two issues are definitively worth mentioning in your letter, while the Omeprazole/Pantoprazole interchange isn’t.

As for the content or phrasing of the letter, that I have no idea, and will leave up to others to help you with.

Ah - that’s interesting to know, actually. My knee-jerk reaction is “what a STUPID substitution” (and to some extent it is), but at least that makes sense. As my omeprazole dose is being tweaked (unrelated to the hospital), this may be a change I run into on a more permanent basis.

Well, I do have to retract that partially - in one document, it was scheduled to be administered at 4 PM but the note says “held/not given because self admin this AM”. Which is sort of strange, as none of my other morning meds have any such note. Well actually, the other morning meds were either skipped entirely in the orders, or are ones I take twice a day. I do know they never offered me this at 4 PM.

The beta blocker was DEFINITELY skipped. As was an antihistamine, a dopamine agonist, and a thyroid medication.

Oh… and I just noticed: the Protonix was supposed to be given at 6 AM. THEY WERE GOING TO WAKE ME UP for that. FUCK THAT!!!

I appear to have missed out on a pretty good partying opportunity, however: I could have had morphine every 2 hours, PLUS Percocet every 6. Why does nobody tell me these things?? ;). (well, I didn’t need them… but I didn’t know I could have asked for them more often anyway).

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Canadian nurse here.

Is this common in the US to have patients self-administer medications? Other than occasional special compounded creams from dermatologists, I am not aware of patients ever bringing their own meds and self-administering. I understand when you have to pay (or your insurance does) for every pill and bandage you would use cost saving mesures where you can.

Now it has been a long time since I worked in an accute hospital setting, (and in nursing homes NO WAY could patients self-administer) but I would be very uncomfortable with my patient having their own pills at bedside. Also I wouldn’t administer a drug that had come from home, I have no way of knowing if it had been altered or expired, or exposed to light, heat or moisture.

As a nurse I take responsiblity for what medications my patient has taken, when how much and with or with out food, etc. Self administering sounds like a nightmare to me. On the other hand, maybe this is common. It does make me glad I am working in Canada, and my patients do not pay for their in hospital medications. (I mean dircetly, of course taxes pay for it, which means I pay too.)

[/hijack]

I don’t honestly know how common it is - I think in general, the hospitals do expect to administer all medications. Well, I was told to bring my own inhaler prior to surgery and in fact they had me use it just before they wheeled me away.

You make valid points about not knowing if the meds are sound, etc.

But there is a significant cost associated with hospital-administered medications. For example, my insurance company was billed 160.00 for the inhaler I refused. Of that, I’m supposed to pay 30. For two doses. I assume they’d have insisted on removing the inhaler from my hands after that second dose, and then it would have gone to waste. Whereas the insurance (and I) normally pay that much for a full month of therapy with that same inhaler.

And, there is as I noted a significant error rate in such prescriptions. In my case, a 100% error rate - both hospitalizations where the hospital managed my meds, things were omitted. So you might see where I find hospital pharmaceutical management… untrustworthy at best.

Now, for non-routine stuff, that’s a different story. I don’t keep vials of injectable morphine lying around. Or even Percocet (er, since I used less than 1/3 of what they sent me home with, technically I guess I do keep that lying around, LOL).

BTW, I will be arguing with the hospital billing folks about the inhaler. It never got within 10 feet of me… and given that I actually do have cause to file a formal medical complaint (for the monitoring which was not performed), I think they’ll be glad to write that off. I was actually surprised that was the only incorrect medication on the bill.

Why would you want to cc this to your primary care doctor? Can’t you just tell him or her that you had bad experiences with this particular surgeon and this hospital?

The hospital does not want you to take your own home meds for several reasonable reasons.

Too many of people aren’t very aware of what they are taking, how much, or how often. Also, some people tend to mix old and new prescriptions into the same bottle. Sometimes the Doc changes your orders and says " just take two instead of one" or “take half” but doesn’t issue new, written instructions or fill a new Rx.

(I know how much the SD likes FOAF stories, but I had a friend die from doing stuff like that- she saved every prescription, but was perpetually confused about what she was taking and how much and when. Heck, some of her old, saved, prescription pills were so old they crumbled! She had about 50 bottles and many had mixed meds in them. After her death, her sister and I inventoried her prescription bottles and we were appalled by the number of prescriptions, doctors prescribing and condition of some of the pills. )

Now, you can take home meds if the Doctor writes an order that says it is OK for you to take them (and there are good reasons why home meds are a good idea- particularly thyroid, for example). You should have filled out or reported a complete list of exactly what you are taking at admission. Usually, your doc will write an order to continue those meds while in the hospital.

The nurse will need to collect your meds and have them verified by the pharmacist. The nurse will then keep them in the med room/cart and administer them back to you as ordered. That way a record can be kept of what you had and when.

Some of the errors you report are nursing (meds skipped) and some are doctor (wrong dosage, wrong med).

I think if you had an unhappy experience at the hospital you should send your letter, but I also wonder how much of your unhappy visit was somewhat preordained by you.

I’m not excusing any mistakes made by the hospital, but you seemed prepared to be unhappy by your telling them upfront that you mistrust hospitals, then were (perhaps) frustrated by having a complication and having to stay overnight, and then searching your record for errors.

I’m not really sure ‘the hospital effed up on your med orders’ when the surgeon actually made the orders, the pharmacy substituted a comparable med for an ordered one, and the Doc didn’t know that one of the new meds you take don’t seem to be helping you. I mean, in the last case, did you tell him that beforehand? Is it really an error that he ordered meds you don’t like or didn’t use?

You should not be billed for an inhaler you didn’t use, but then you said you only used it twice. I can’t tell it it was yours or the hospitals. If it was the hospitals, you did use it twice, and it’s an ordered med that you regularly take, I would have sent it home with you when I returned your home meds. I’m also confused that “monitoring” is a “med”. That seems unusual.

Oh, I do agree. While I know my meds are fresh… I also know some folks are scary about stuff like that. I used to surreptitiously toss stuff from my Mom’s house, and argued with her when she insisted on using a 10-year-old bottle of athlete’s foot meds on her massive abdominal fungus rash :smack:.

I did in fact report a complete list - which appears several times in my records. Just curious - why do you specifically mention thyroid? That was in fact one of the ones the doctor didn’t order.

And that would have been perfectly acceptable.

Actually, no meds were skipped by the nursing staff, it was solely things omitted by the doctor.

Well, from prior history, I’ve learned that they (“they” meaning the doctors and/or nurses, not pinpointing one vs. the other; I’ve seen errors definitely attributed to one vs. the other at different times) can NOT be trusted to get the meds correct, though, so I was already being vigilant. Rightfully so, unfortunately.

I actually didn’t plan on “searching for errors”… until the problem with them not doing the needed monitoring. But because of this and prior experiences, I tend to have a hair-trigger on the subject. Not entirely unjustified, I think.

Re the pharmacy substitution - that was out of the doc’s hands; he actually ordered the normal med (come to think of it, shouldn’t he be mad at the hospital for overriding one of his orders??). It’s a silly thing - while another poster upthread said the substitution has a better safety profile for most people, what if it wasn’t the case for me?

It was indeed the surgeon who made the incorrect orders. What I’ve taken home from this is that I must - in light of these errors - either provide my own meds, or at the least, receive a listing of everything that has been ordered so that I can verify it.

The surgeon did not in fact know that the one med might not have been helping; we’re still not 100% sure it was helping or not (it was for blood pressure, and my BP had not lowered since starting it). That was really an aside, and not relevant to the discussion - I mentioned it here just as an example of why missing the other med might have been especially dangerous. The point that the other BP med was omitted is what I’d mention in the letter.

No, I didn’t use their inhaler; I used my own. Their inhaler never got within 10 feet of me. The other time I used a hospital-provided inhaler, they brought inhaler A in the evening, and I never saw it again (they brought inhaler B only in the morning, instead of A and B both times). So my insurance paid a small fortune for 2 puffs of an inhaler.

Not sure how you saw me saying “monitoring = med”. The monitoring was for pulse oximetry; the surgeon saw that I had recently been diagnosed with apnea, had not yet received a CPAP, and wanted me to stay overnight because apnea patients sometimes don’t recover well from general anesthesia. He ordered the monitoring and it wasn’t done. That was the ONLY failure on the part of hospital staff. In the letter I’ve already sent off to the hospital (with the surgeon’s encouragement), I actually praised the staff for my care in general.

I really do recognize the need for the hospital to verify everything - the standard logic really makes a lot of sense… if they get it right. Trouble is, I don’t see that they’ve ever done that. As long as I’m mentally competent, I will get the meds right.

Oh - and come to think of it, the doctor omitted one more medication than I’d mentioned before: my bronchodilator. I was told to bring my own on that… so clearly the expectation was that I’d use my own. That does NOT mesh with the “hospital handles everything” mentality. If I’d needed it (and I did, once, during the afternoon), I’d have had to wait - struggling to breathe, and coughing with a painful abdomen - until they chased down someone willing to order it for me. Now that’s dangerous!!

The bottom line is, the doctor omitted some meds that I was on for valid medical reasons, one of which could have endangered me (and others which certainly would have made me uncomfortable). I really feel I have an obligation to point that out, if not actually report it to any authorities.

Perhaps your letter could mention your preference for using your own pills, note the discrepancies between what you usually take and what was ordered, and suggest that there is probably a better way for all sides to communicate here.

Last time my husband went into the hospital, even though it was for outpatient testing, it required adjustment of his daily medications. This was explained to both of us in advance both so we could understand it, and so I could keep an eye out while he was under the effects of anesthesia to make sure he wasn’t, for example, accidentally given someone else’s meds. He couldn’t use his “home” meds, but we knew exactly why things had been changed, any substitutions made, and they even gave us a printout of the important points to carry with us. Hey, I think it was all around a good way to do it.

Sounds to me like part of the issue in the OP is communication. There are good and valid reasons (as others have noted) for not allowing patients to bring medications from home. On the other hand, if there is a medical reason for an exception to be made then the hospital personnel really do need to be informed of this. If changes are made to a patient’s normal medications that also needs to be explained to prevent undue anxiety and/or complications.

My dad worked as a hospital pharmacist for a couple decades. Yes, the pharmacy, as well as the nurses, like routine and consistency but there were plenty of times dad went to extra effort to get a specific medication for a patient who truly needed something they didn’t normally stock, or otherwise make an exception for medical reasons as long as someone told them of the need.

(And sometimes just humane ones - apparently a lot of people with nausea really do prefer specific soft drinks above others so at one point he argued for keeping a stock of specific name brands exclusively for the chemotherapy patients, the cafeteria/catering soft drink contracts be damned - I think his words were something like “I’m not telling a terminal cancer patient they have to drink Pepsi instead of Coke. Or vice versa.” Strictly speaking not a pharmacy issue, but he went to bat for it anyway.)

Thyroid medications, like Synthroid (levothyroxen) and Armor Thyroid have a very narrow therapeutic window, the dose difference between useless and toxic is small. It is not a good idea to change drug manufacturers without reason.

If you actually needed a particular drug that wasn’t on the formulary, the doctor would have to specify “Dispense as Written” and the pharmacy wouldn’t substitute. Most hospital pharmacies keep a certain amount of non-formulary drugs in stock just for reasons such as this.

One generic comment to add is that it’s quite common for certain medications to be held or modified during the intra-operative time span.

No advice, but when my dad was in the hospital post-op (orthopedic tib/fib surgery), the nursing staff tried to give him insulin. He’s type 2 diabetic, never been on insulin, never had an prescription for insulin - you get the drift. He had to refuse it three times (I was in the room with him) and show the notes in his chart to the nurse before she would leave him alone.

Eek. That’s pretty terrifying!! Was it the same nurse each time? Did you let someone higher-up know?? I’d think they’d want to know if one of their staff was THAT determined to do away with their patients (bad for repeat business, dontcha know).

I know an OD of insulin (and if one’s type II and not on the stuff, “any” = OD) can be very bad. I used to share an office with a fellow who was Type I, dx as a child, and he said one of his greatest fears is that if he passes out from low blood sugar, someone well-meaning might come along, see his insulin, and give him a shot… thereby possibly finishing him off.

Understood - and that’s where the communication MUST happen. Well, “intra” isn’t exactly the right word since that would imply “during” surgery… at which time even I fully admit I was probably not up for the task of managing my own meds :wink:

It’s unlikely that they’d want to eliminate BP meds… given that at every reading the BP was fairly high. Increase? maybe.

My plan for the moment is this:
I’ve drafted a letter to the doc, including toning down the “YOU EFFED UP” language quite a bit!! I see my primary care doc in a couple of weeks and will discuss the situation with her. I know her, have been a patient for nearly 12 years, she also knows me and that I’m… proactive… about such stuff. After that, I’ll presumably send the letter. In the interim, I’ll just send the doc a copy of the letter I wrote to the hospital, as a courtesy.

See, this is exactly what I’m talking about. The change in diet as well as the stress of a surgical procedure plays havoc with your sugar balance*, add to that some post op nausea and it’s not uncommon for type 2 diabetics to get insulin in the short term (not commenting on Avarie573’s case)

*broken bone or surgical procedure -> stress hormones -> release of sugar stores and increased white blood cell count.

Very true… but from Avarie573’s tale, the nurse was trying to administer medication that was expressly contraindicated - see the mention of the chart. We don’t know if her father tested his blood sugar etc. so there’s missing data.

I’m borderline Type II (one high glucose reading… one barely-high A1C reading with near-normal glucose on a different occasion from the high glucose) and that was documented by my primary doc in the pre-op paperwork, and what’s funny is the subject of blood sugar management never even came up. I’d have definitely asked a LOT of questions if someone had come at me with insulin.

Oh - and in the case of the dad with diabetes: the possibility of insulin is something that should have been expressly discussed with him, if it was something that might crop up. I assume a well-educated diabetic is VERY used to managing his condition (one would hope, anyway) and so is not going to accept a sudden change, with no explanation. It’s a communication thing; Dad had no history with or reason to trust that nurse.