A few weeks ago .. I wrote about my wife being Dxed with A-Fib and being hospitalized https://www.pharmaciststeve.com/?p=3854
I had issues with the cardiologist from nearly the get-go.. He was wanting to put her on Xarelto … he didn’t notice – or care – that there was a level one interaction with one of her existing meds and since she was already on a “ton” of meds… who knew what other interactions that would/could happen.. and of course.. this drug HAS NO ANTIDOTE ! I reluctantly agreed on being discharged on Pradaxa..
At first.. he wanted to see her within a week and then… for some reason .. after our “turf battle”… he did not want to see her for month +.. she is still not in sinus rhythm .. After seeing her PCP a week after discharge.. he was rather put out that the cardiologist had not seen her and/or she had a near appt to see her… a phone call from the PCP and a appt within days was arranged..
I was there with her at this appt.. In reviewing his notes.. he stated that “I thought she was discharged on Xarelto ?” and I mentioned the level one interaction.. well that was like water on a ducks back.. change subject.. to discuss putting her on Warfarin and getting her ready to be “shocked” to cardio-convert her.
So she starts on Warfarin that day.. and a scheduled to do a INR in one week at a clinic in the same bldg .. ran by some female – a nurse maybe… I was unable to go with Barb to the INR testing… Barb described the “clinic” as looked like it was furnished out of a Goodwill store.. now I don’t expect Ritz Carlton decor.. but…
Test was done.. and the “clinician” asked Barb what strength of Warfarin she was on.. she could not remember.. so the “clinician” showed her a brochure of COUMADIN and asked her to ID via color.. well her WARFARIN was a different shape and not right-on color with COUMADIN.. It would seem that after one week.. her medical records from the cardiologist had not been updated yet from her visit.. Instead of calling the pharmacy who filled the Rx… back to the color ID.
The report that she sent home with Barb… showed that her INR was the same 1.1 as when she was admitted to the hospital weeks earlier.. after being on 4 mg of Warfarin daily – WTF ?
.. I know that there are some DNA testing that can be done to ID pts that have metabolism problems with WARFARIN.. but… that takes time and money…
The “clinician” told her to increase her 4 mg to 6 mg.. she told her to split the tabs.. and Barb knew that I had said that breaking tabs resulted in a 20% +/- of intended dose and that I wanted whole tabs to be dosed with this NTI drug.. The “clinician” was suppose to call in a new Rx.. this was Wednesday… Wednesday night.. no Rx at the pharmacy.. Thursday night no Rx at the pharmacy.. Barb goes into the office on Friday and the office manager made the statement ” you expect a new Rx to be called in the same or next day ?” and “besides the pharmacy should be calling us to see if we have a new Rx for you ” WTF ?
On top of all of this.. the report sent home instructed Barb to take specific doses of 5 mg and 2.5 mg… but was told verbally to take 6 mg – WTF ?
On top of all of this.. Barb is displaying some minor bruising … increase the dose by 50% WTF? – I told Barb not to change dose.. until we can get another INR testing…
Friday night… I get home from work.. I am livid and going ballistic over all of this… I sit down and type a letter to our PCP and scan down the report and fax it to the office and attach to a email and sent it to his personal email address.. I get a call from him Saturday afternoon… the cardiologist has been FIRED and the PCP is going to take over getting her stabilized on Warfarin .. she goes into his office on Monday for another INR test… so that we can get her into the position to get her cardio-converted and find a new cardiologist.
How do older pts do things properly.. with this type of medical care.. I am sure that this is not a isolated incident from healthcare professionals in our country … it is no wonder they claim that our healthcare system kill 100,000+ pts every year… from mistakes and errors
Filed under: General Problems
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My mother was admitted to hospital for evaluation of new onset headaches. Her INR was was low and she was to be bed bound for several days. They failed to start her on any type of heparin or low weight product. She has a mechanical heart valve. Luckily I visited the next morning. I promptly called their risk management department and told them this needed to be addressed immediately as she had already lost vision in one eye due to sub therapeutic anticoagulation on her last hospital stay in this same facility. They didn’t miss any more doses….
I could relate to you two different stories concerning my parents healthcare before they died. My mother went to one hospital and my father another one. The stories are diametrically different. My mother got poor care and my father got excellent care. I was surprised to learn, just 2 days before she died, that my mother had bone marrow cancer. Months before she had a bone marrow biopsy. She had frequent blood tests. Did they not notice the calcium levels rising in her blood? All I can say is that you better get all tests results and examine them yourselves. And, if they do something like a biopsy and they say they will call you if anything is wrong, you better call and get the results yourself. You cannot rely on physicians, nurses, or anyone else. You can only rely on yourself. This make you wonder about all these folks that cannot or unable to follow their own tests and arrive at their own conclusions. Just how many of them does our healthcare system kill each year? What is so surprising to us pharmacists is that we are so much more efficient than all these docs, clinics, and hospitals. If we made the errors they do, we would be out of a job quickly. The one thing I can say about pharmacy is that it is a profession where there is a high accuracy rate. One of the things that you seem to have experienced and what seemed to be the problem with my mothers healthcare providers was bad communication between providers. If there is this poor communication, a hit or miss type thing, between physicians, clinics, and hospitals, then anything can happen. The push for electronic records is needed and those records need to be readily available to anyone in the healthcare pipeline. The VA has what appears to be an excellent system. There is a lot of documentation by each provider in the system, and each provider can access that information. The government in passing HIPPA has caused a lot of problems and slowed the pace of sharing information that is vital to good healthcare outcomes. I think it is one of the biggest blunders made in healthcare in a long time.
Your wife is very lucky to have you and your PCP in her court. I hope you can get resolution quickly.