The older my patients are, the more often I prescribe them several medications. The interactions are reminded to me by the program stored in the PC for each prescription. I usually put up with one or two interactions and side effects. That’s why I plan to do one or two follow-up checks. The interactions and side effects are therefore more or less predictable. I print out a current dosage card for the patients and hope that they always carry it with them.
Many of my elderly patients are cared for by Spitex. Your staff often fills an entire week’s worth of medications into the clear medication boxes. In this way, compliance can be sustainably increased. Medication is usually dispensed on the basis of a list prepared by Spitex, which is faxed to me for the visa. I compare the Spitex medication list with the current list stored in the PC and do not visualize it. Yes, I don’t visor the list, but reprint an updated dosage list that I fax back visored, which occasionally causes irritation. Unfortunately, my attempt to ensure that my patient is treated only according to my dosage chart fails fairly frequently and there are at least two lists in circulation. Thus, there is a risk that the two lists will not match. Every change in therapy must therefore be entered on two lists. This means that the patient must be given a printout of the updated dosage chart and the Spitex must be informed so that they can adjust their form. Depending on the organization or employee, I receive this form by fax for control and visa. All clear?
Now, when my patient is discharged home after a hospitalization or rehabilitation stay, she takes a preliminary discharge report and prescription with her. The report, which would actually be for me, is neatly punched and filed into the Spitex documentation and the medication is entered into a new dosage chart, which is then usually faxed to my office for the visit. My MPA subsequently tries to organize an exit report. It is not uncommon for the medication before and after hospitalization to be identical. However, one or the other generic drug was substituted for an original on the assistant’s prescription. Of all the medications listed on the discharge report, one OP is prescribed. The prescription is usually filled without delay, even though there are already large packs of most of the permanent medications on the patient’s kitchen table. If the patient is cared for by Spitex, the medication salad can usually be cleared up in time. If the patient procures her medications herself, it can happen – as happened a few weeks ago – that three medications are taken as both originals and generics.
“Many cooks and recipes spoil the broth!” or “Formalized safety can be dangerous!”
HAUSARZT PRAXIS 2014; 9(4): 2
