Recently I wrote about my concern when dad’s assisted living facility ran out of his blood pressure medication in “I Must Be Doing Something Wrong” , “Dad’s Medications — Part 2” and “High Blood pressure — Dad’s and Mine“. I wrote that dad went at least 4 days without any blood pressure medication. In response to that post, I got a lot of valuable feedback, including Terry1954 who suggested I contact the ombuds person.
I waited a bit to deal with my own rising blood pressure and then I did contact our county Long Term Care ombuds person. She was very sympathetic to my concerns and felt that I should talk to the Assisted Living Facility manager. She knew the manager and thought she might not be aware of the problem. If I failed with the manager, I should contact the state health department and she gave me a telephone number for them as well.
Almost 2 weeks ago, I did go in and talk to the ALF manager. It appeared to me that she was very aware of the issue, but asked for a few days to get more information on exactly what happened. We agreed to talk again the following Thursday after she got more information. I wasn’t upset by this request as when I used to work in a hot seat type of job, I always wanted the complete outline of the problem before I had to respond to it.
When I went to see the manager the following Thursday, she was on her way out to a meeting and I was annoyed to be “blown off” like that. I made another appointment for the following Thursday, giving myself time for the visit from my brother and sister in the intervening days.
Thursday we had that meeting. The manager went over the details of what happened day by day. I asked for the protocol of ordering medications and what they do when the medications don’t arrive. She explained that the doctor (who sees residents right at the ALF) desires to have prescription renewal requests faxed to her. So, that is what the protocol specifies. If the resident has no medications on any day, again the protocol is to fax and notify the physician.
There were several errors in the process for my dad. First, the doctor did call in the prescription, but to their local pharmacy rather than to Medco, the only pharmacy covered by his insurance. Second, when it arrived from the local pharmacy with a different brand name than they expected, they sent it back. The manager accepted responsibility for that error.
However, they also sent several faxes to the doctor requesting a replacement prescription and the doctor did not respond to those faxes until dad had been out of medication for several days already. She felt the blame for that should go to the doctor. I said that while I agreed that they had followed the doctor’s desired protocol, there had been a breakdown in communication. For while they felt they were communicating with the doctor, no one was responding.
I felt there needed to be a way for them to follow up when the doctor doesn’t respond so that the resident doesn’t end up without his medications for so many days. In the end, she agreed that they would telephone me if they didn’t get a response from the doctor. Then I will follow up with the doctor as well, and I won’t just send a fax. I understand that they need to work with this physician regularly; I also want someone to be responsible for following up when things don’t go smoothly.
If this were a nursing home I would expect more because the nursing home has doctors and physician’s assistants right on their staff. I chose this ALF because it wasn’t too large, and I know this may limit how much they can do sometimes.
So, I ended up taking more responsibility for myself whereas I think the responsibility should be theirs. Nevertheless, the bottom line is that I don’t want dad to run out of his prescription medications. The manager didn’t think this would happen again as it had never happened before. Either way, I want them to know I am watching and I will pick up the process if it comes to a dead-end again.
I decided not to telephone the health department to file a report at this time. If it happens again, I probably will. It seems to me that the health department needs to hold the doctor’s office responsible as much as the ALF. But in the meantime, I will just stay involved in the entire process. It isn’t the ideal solution, but it looks like the best one I can get.