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Unclear discharge notes lead to medication starts and stops

Contemporary Long-Term Care Weekly, September 11, 2008

Poor information from hospital discharge records is a major reason why so many nursing homes are struggling to conduct comprehensive screenings and assessments of short stay patients to determine whether this population needs to be treated for a chronic condition.

According to a CLTC poll conducted August 28, 65.3% of 104 long-term care organizations responding say it is increasingly more difficult to distinguish a Part A patient’s chronic condition (such as chronic depression or chronic obstructive pulmonary disease) from situational issues such as depression due to being in a nursing home, or pneumonia.

Some nursing homes attempt to manage medications and costs by establishing a Part A formulary (57% of those surveyed have a Part A formulary). But this management is at times put at risk when there are gaps in the information nursing homes receive upon admission.

Hospitals, according to the poll, often send nursing homes information on what lead to a patient’s hospitalization, but no information about the patient’s current conditions or medical history. With incomplete discharge records/notes and a reluctance by some acute care hospitals to share complete histories, nursing homes are in a difficult position—they can’t in many cases comprehensively assess chronic conditions and yet they are at risk of citations for failing to identify and properly treat patients.

We’d like to hear from you. If you have concerns about patients stopping and starting medications as they move through the continuum, let us know what concerns you. Share your specific stories and suggested solutions. E-mail correspondent Bryan Cote at Bcote@hcpro.com.

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