In the days since I wrote about dad’s blood pressure medication in I Must be Doing Something Wrong and Dad’s Medications – Part 2, I have come to realize that I have a blood pressure problem of my own.
While I was waiting to see dad’s doctor on Friday, I went to the store and purchased a blood pressure cuff. My cardiologist had suggested I purchase a cuff and have the pharmacist check it against theirs to be sure it was accurate. The one I had been using before was a wrist cuff and was not accurate when checked in the cardiologists’ office. However, there was no pharmacist on duty when I bought my new cuff early Friday morning so I would have to wait to check it for accuracy.
My blood pressure medications were changed in the past few weeks due to a conflict with other medications and medical issues I had. I didn’t get a chance to try out my new BP cuff until Saturday evening and oh boy – it was through the roof! I thought the cuff was probably not accurate and set it aside.
Monday I took my new blood pressure cuff to the pharmacy where I had purchased it and the pharmacist checked it against theirs. My blood pressure was still high, but not close to what the cuff I had purchased had measured. The pharmacist suggested I return it for another but I didn’t bring the box and receipt with me so I set it aside until the next day.
Tuesday I took it again with the box and the receipt to the same pharmacy and they took one off the shelf and I asked that they check that one against their own. Again the one I was about to purchase was very high but was also much higher than their own cuff. Either way, it was still above where it should be, so they said I should consider it high and see my cardiologist. I purchased the new meter and took it home. I took several readings at home and all were high.
This morning I called the cardiologist’s office to see if I could bring in my new meter to compare to theirs, and also to ask if I should have my medications adjusted. They said to wait for the nurse to phone me back. Well, you know how that goes – it took 3 more hours before she called me back. She said I should go in tomorrow and see the cardiologist and bring the new meter with me.
So, I sat frustrated all morning, waiting for a call back while the weather outside was finally beautiful. When I got my call from the nurse, I decided to take a walk, but the weather had suddenly turned and it was raining and windy. Later I finally got to take my walk after the cold front had passed.
In the meantime, I went to visit dad Tuesday. I stopped by the nurses’ office to make sure they had received the medications I had brought in from Medco over the weekend (when the medication technician was not in). While I was in there, the aide told me that “It wasn’t their fault that dad had missed 4 days of medications last week.” I wasn’t going to bring that up yet as I was so flustered about my own blood pressure.
I responded that I wasn’t interested in determining fault. I was interested in finding a way to prevent the same situation in the future. The way I see it, the medication renewal protocol is a system that failed. The plan is that when a residents medications are about to run out, the ALF phones the physician to renew the prescription. The physician phones the pharmacy or Medco and the new medications come before the old ones run out.
That system failed for several reasons. The ALF did telephone the doctor as specified in their protocol and the physician did phone a pharmacy with the renewal prescription. Here is the first break-down as she should have phoned Medco and instead called their local pharmacy. The local pharmacy did send a 30-day supply as the physician had ordered. But the medication was not recognized by the ALF. This medication was a different brand name for the generic that dad was taking.
The ALF returned the medication to the local pharmacy and the local pharmacy destroyed it. Here is the 2nd place the system broke down. The ALF didn’t phone the physician again but instead asked the pharmacy to send the expected prescription. The pharmacy said they couldn’t as they had destroyed it. They needed a new order from the physician.
It seemed to take 3 days for the ALF to realize they had to call this in again to the physician. And the physician didn’t get that message for several days. In the meantime, I asked daily if dad had his renewal medications and I became more and more frustrated as it became clear that he had no medication at all for the whole week. Finally the nurse phoned the pharmacy again and they must have phoned the physician’s office and finally got renewal medications sent back to the ALF.
The physician told me she didn’t know the ALF was waiting for her to phone in another prescription to Medco and the local pharmacy.
It seems to me that there are enough errors for the blame to be shared. But what I really want is for them to come up with a plan to prevent a recurrence of the problem. I want them to look at it in terms of system analysis – where you find the weak point in the system as it is currently set up and then make a change to prevent the same errors in the future.
However, the ALF doesn’t think they made any errors and they don’t plan to make any changes in the future. I want them to phone me the next time dad’s prescription run’s out so I can follow the progress of the renewal by myself. I noted the dates that dad’s 2 prescription are up for renewal (about 90 days from now) and I will check in with them a few weeks before that. Maybe I can control my blood pressure by being proactive about dad’s blood pressure medications!