Home Health Medications: What's Actually in the Cabinet | Episode 89

Episode four of the medication harm series is the patient's home, a setting most attorneys don't think of for medication cases because the home health nurse isn't administering the drugs. Michelle Carroll explains where the liability lives instead. A patient comes home from the hospital with a new medication list while the old bottles are still in the cabinet. Some drugs were stopped, some changed, some replaced. Federal conditions of participation require the home health nurse to do a comprehensive medication review at the first visit, which means looking at every bottle and reconciling against the discharge list. If that was done, the chart shows it. If it wasn't, the patient is taking the old blood pressure pill and the new one together. She walks through the OASIS, the federally required assessment whose medication items drive the agency's reimbursement and public ratings, and why those items must be checked against the visit notes. She covers the ability-to-self-administer assessment, the plan of care as the agency's own standard, and the physician notification log, where a fax at 4:40 p.m. for a blood pressure of 84 over 52 is notification in the technical sense only. A composite case follows a man discharged after a heart failure admission whose discontinued drug stayed in the pill organizer, whose new dose was never filled, and whose Saturday after-hours call was answered with "hold diuretic, call if worsens." By Tuesday he had a hip fracture. The episode closes with the defense's "family administered the drugs" argument and a discovery checklist that ends with the one piece of evidence the agency doesn't control: the bottles. Lexcura Clinical Insights is hosted by Michelle Carroll, Founder and Chief Clinical Strategist of Lexcura Summit. Medical-Legal Analysis for attorneys. lexcurasummit.com