Wednesday, April 18, 2012

Priorities: Patient or Paperwork?

When I took Robert to a walk-in clinic on Monday, I knew it wouldn’t sit well with his Care Facility (otherwise known as “New Home”).  It had to be done, though.  Robert had a cough for several weeks which I asked to have checked out several times but the doctor Robert had seen at the Care Facility thought he was fine.  When he was at our house, he was running a fever and clearly not himself.

He was most certainly not fine.

A doctor’s visit was in order so I took him in and Robert was immediately put on antibiotics.  It was a strong prescription so had 10 days of medicine packed into five days.  Since he was staying with us for a few days, we gave him days one and two; New Home only needed to give him days three through five. 

New Home never likes when I get prescriptions for Robert without going through them (hey, I feel as if I tried. I told New Home Robert was sick and their doctor said he was “fine.”).  You missed your chance, New Home.

My mistake was in forgetting to get the discharge paperwork from the clinic that saw Robert.  I got the script, just not the discharge paperwork.

Boy do I regret that mistake.

After the appointment, I picked up the prescription.  I paid for the prescription.  I even emailed several members of the staff at New Home (which included House Manager, supervisor of House Manager and Nurse Ratchet) and explained why Robert needed the medications, where they were located in his bag and when he needed them. 

Of course, the directions were also listed on the label on the box of medication.

For those on pins and needles: I was even very nice about it (and refrained from addressing Nurse Ratchet by my pet name for her).

I know – I was surprised at how nice I was too.

The email I got back was from Nurse Ratchet was dripping with sweetness (hey, she stole my trick).  Bottom line: they can’t give him the meds without the discharge orders from the clinic.

Fine.  I call the clinic to get the discharge orders faxed to me but they can’t do that because I didn’t sign a form saying they had permission to fax me anything (the one form they didn’t have me fill out, apparently).  I would have to pick up the copies in person.  The clinic was nearer my home than my work and they closed at 5:00 p.m. so there was no way I would be able to do this without missing a chunk of work.  I’ve already missed work this week so chose to pick it up in the morning.  I understood their reason for not faxing the paperwork (confidentiality) but hoped this wouldn’t prevent Robert from getting his medication.

I personally would choose medication over the slight possibility of an infringement of confidentiality but the clinic does not.

I turned my attention back to New Home.  Can you please give Robert his medication tonight and I will fax the paperwork to you tomorrow?  No, they can’t (of course not).

I suggested I come over and administer the medication myself which I didn’t want to do because it would be an extra hour and half I didn’t plan on for the evening but I would if that was the only option.  Apparently, I actually couldn’t even do that because the medication was now in their possession.

Wow.  The screaming in my head couldn’t get any louder.

If Robert doesn’t get the antibiotic tonight, there is a risk his infection will return.  He’s on the mend and I’d really rather have him feeling well than back to coughing and feverish.

Call me crazy but it really doesn’t seem like too much to ask.

New Home’s solution was to copy the medication label (with all necessary “legal” information already on it!), fax it to the New Home doctor, have him write another prescription for the medication (the same medication now in their possession), have his office fax the script to New Home and then, if they get it in time, New Home will administer the medication tonight. 

Are you kidding me?  I’m surprised they didn’t have to actually pick up a new pack of pills.

If I had sent Robert back to New Home with a baggie full of unlabeled little red pills, I could understand the hesitancy to give him a pill.  I assure you, that didn’t happen!

I sent him with a brand new prescription, properly labeled, properly prescribed and he may not get it because they don’t have the “sufficient” paperwork. 

And in this case sufficient equals overkill.

I understand the facility has rules to follow and forms to complete in order to stay within the State’s regulations but when the paperwork becomes more important than the patient, there is a problem. 

The clinic, the care facility and the state (because of their rules and regulations), have lost sight of the priority: the patient.  

How has that happened?

It shouldn’t be this difficult to administer an antibiotic. 

Thankfully, at the end of the day, the New Home doctor faxed the prescription making Robert’s antibiotics “legit” and Robert was given his dose for the day. 

Maybe tomorrow everyone can work on their priorities. What form can I complete for that?


Ally said...

Omg, what a nightmare. I'm so sorry you had to go through that. I understand heathcare staff and companies have their rules they have to abide by but sometimes common sense takes a backseat to all their guidelines and protocols. Ridiculous! These are human beings their dealing with.

Glad things worked out in the end.

Trish Hughes Kreis said...

You are so right, Ally, common sense is widely lacking in the healthcare profession right now. I appreciate you stopping by!

Paula Schuck said...

See and that is simply a symptom of all crazy systems right now. I have a dd with special needs too and it seems to me there is an eliding of stupidity and a lack of common sense any more. I get this totally. They might have at least given one pill and let you in the morning get the rest in order. Annoying and aggravating.


Paula Schuck said...

That was supposed to say epidemic of stupidity. Whoops!

Trish Hughes Kreis said...

Paula, I love that: an "epidemic of stupidity" - so true! It makes me wonder how much this lack of common sense is costing the state. Were they billed twice for the same thing (for the doctor I took him to and then the house doctor for rewriting the script)? It's so aggravating! On the plus side, Robert is feeling sooo much better. Thanks for commenting & tweeting. I appreciate it!

Judy Stone-Goldman said...

I just wrote a long comment but had trouble signing in, and my comment disappeared. Just a tiny bit of frustration--nothing compared to what you've gone through! To want nothing but to provide care and to be stymied by red tape and protocol must be the worst daily stressor for caregivers.

Hope Robert is recovering well. And I hope writing this at least reduced some stress for you. I know expressing myself in words really helps release frustration.

Judy Stone-Goldman
The Reflective Writer
Personal-Professional Balance Through Writing

Franziska San Pedro said...

I get mad just by reading this!
They are sooooo scared of getting sued that they are doing the silliest things and not using any common sense. It's crazy.

Glad they finally found a solution -I am still mad though. Thanks to your persistence, you got it all worked out.

Trish Hughes Kreis said...

I'm still mad too, Franziska! Common sense is never part of equation at these homes. It has to be partly ego, partly the state requirements (meant to help the resident but discouraging the use of common sense!). I get fired up every time I think about it. Happy to hear from you! Hope you've been well.