The risk of medication errors in long-term care facilities is a serious issue. In last week’s post, we heard about Rose, an elderly woman who experienced dangerous medication errors while at several rehab facilities. Unfortunately, medication errors in long-term care and/or rehab facilities are common and dangerous. Fortunately, you can reduce the risk of medication errors in long-term care facilities, whether you’re the patient or family member. Choosing a well run facility (when possible) and advocating for yourself or a loved one can help you avoid medication errors. But, as we learned from Rose’s stories, mistakes can happen even under the best of circumstances, no matter what you do. And that is scary!
The path to a long-term care or rehab facility.
Patients generally go to a rehab facility (also called skilled nursing facilities) after a stay in the hospital to receive daily medical care during recovery. Long-term facilities, often called nursing homes, generally provide care for people who need help with daily living skills (eating, dressing, etc) but don’t need the services of skilled nurses or other professional medical staff.
Often, the hospital admission is unexpected, such as after a stroke, a broken hip, a horrible accident. But sometimes you schedule a procedure weeks or months in advance, like a hip or knee replacement.
In all scenarios, regardless of how you arrived at the hospital, where you end up for rehab care depends on several factors. The hospital discharge team looks for a bed in a facility that not only has an opening but is able to take a patient with your specific medical needs. Sometimes you have a choice, and sometimes there is only 1 option available.
Can you review potential facilities?
While it is hard to determine your risk of medication errors at any facility, you can evaluate facilities overall. Medication errors are less likely to occur in facilities that are well run with reasonable staffing schedules, adequate staff:patient ratios, robust training programs, and systems in place to avoid medication errors. For more information on read my blog: Nurse Stress and Fatigue Can Impact Your Health.
It’s important to understand that even if you know which facility you would like to use, it may not be an option. As mentioned above, a facility must accept a patient, based on availability, your medical condition and your insurance.
How to research facilities.
If you are planning for a procedure that will require rehab care, you can do some research before your hospital stay. Using the suggestions below, I recommend you make a short list of preferred facilities, as well as a list of those you want to avoid. Hopefully a bed will be available in one of your preferred locations.
In all likelihood, the discharge team will present you with a list of available options. If the list includes options you already know and want, you’re in luck. But if you receive a list of facilities that you are not familiar with, you should have time, even while in the hospital, to conduct some quick research.
The first thing you should do is get personal recommendations. Ask your friends, neighbors and relatives if they, or people they know, have stayed in a long-term care or rehab facility in the past year or so. Where do they recommend you go? Conversely, where do they recommend you avoid?
Do some web sleuthing.
Then you can do some computer sleuthing. Look over the websites of facilities. Additionally, conduct an online search to see if there have been complaints or articles relating to the quality of care. Type in the name of the facility with the search terms “complaint”, “quality of care” or “medication errors”.
You can also research facilities online, using these sites:
- Medicare.gov Inpatient Rehabilitation Facility Compare
- Medicare.gov Nursing Home Compare (also includes some rehab facilities)
- U.S. News & World Report – Best Nursing Homes (includes some rehab facilities)
Pick up the phone.
You can call facilities and ask them for information on staffing ratios (including number of nurses and CNAs (aides) per patient) and the normal number of hours each nurse, CNA and doctor work every day. Additionally, ask what systems they have in place to reduce medication errors.
Time for a visit?
Although this is often not possible, if you can, you or a loved one should visit each facility you are considering. How do the nurses and staff treat the patients? Do the patients look happy? In pain? Are patients physically restrained? Does it smell? Does the food look appealing?
How to reduce the risk of medication errors in long-term care facilities.
While you, or your loved one, are staying at a long-term care/rehab facility, it is vital that you stay alert regarding medications. Importantly, experts estimate there is one medication error per patient per day!
- Keep at your bedside a complete list of all medications prescribed, as well as for over-the-counter medications.
- Ask the staffer to confirm the name and dosage of each medication before it is taken.
- If a staff member gives you a medication that doesn’t look familiar, do NOT take it without getting clarification. Ask to speak to the charge (head) nurse if you don’t think you should be taking a particular medication. If you don’t get an answer that seems logical to you, ask to speak to your doctor, or the doctor covering the floor. Be insistent. As you saw from Rose’s experiences, sometimes being insistent helps, and other times staff won’t listen no matter what you say.
Can you switch facilities mid-stay?
Sometimes, but not easily.
No one loves staying in a long-term care facility, and there are many shades of terrible. There are plenty of things to complain about – the food, nurses waking you up in the middle of the night, loud roommates, and more. Or perhaps the facility is very far from loved ones, leaving you isolated and lonely. Maybe it’s a bad fit due to religious or other personal reasons. But, sometimes, a facility is sub-standard, where patients are neglected, and their health is at risk.
If the patient is in danger due to negligent care, move the patient as soon as possible. This will likely involve calling facilities to see if they can accept the patient. If you can’t find an opening in a suitable facility, you might want to bring the patient home for a few days while you look for other options. Beware, you might lose your insurance coverage if you take a person home.
If the situation isn’t dangerous, but the patient wants to move, you can do some research and make some calls. You may end up deciding that a move is too difficult. Or a move may jeopardize your current insurance coverage for this “event”.
And, realize that transfers between facilities almost always involve ambulance transport.
For more information on medication safety, read my blog posts:
- Reduce your Risk of Medication Errors
- Easy Steps to Take Medication as Prescribed.
- Are Antibiotics Helpful or Harmful? What You Need to Know.
- Doctors Prescribe Too Many Medications.
- Are Medications Safe?
- Is Off-Label Medication Safe?
- Can Your Medication Make You Sicker?
- Nursing Home Safety Issues Can Pose Dangers for Your Loved Ones.