Preventing Medication Errors During Nursing Home Admissions
Could a simple mistake during nursing home admission put your loved one’s life at risk? Medication errors often happen when new residents are admitted, leading to serious and sometimes fatal consequences. These mistakes are preventable with the right systems and attention to detail. In this week’s episode, nursing home abuse lawyer Rob Schenk welcomes guest Shanna Rittberg to talk about how and why medication errors happen during admissions—and what nursing homes must do to keep residents safe.
Rittberg:
I think having that open conversation and even you have the ability to get, make a list for the family, or there’s a way to document what everything the resident is on and just keeping open communication and asking them how they’re feeling, what they’re, what they’re doing in the facility on a day-to-day basis.
Schenk:
Hey out there. Welcome back to the Nursing Home podcast. My name is Rob. I’ll be your host for this episode. We are talking today about. Reducing the likelihood of medication errors during that small window of when the nursing home resident is first admitted to the nursing home. So we’re gonna be talking about the process by which the residents medications and their prescriptions actually make it into the building.
And from there, how it’s entered into the electronic medical record system and all that kind of stuff. And what we can do. To reduce the likelihood that there’s gonna be problems with that, but we’re not doing that alone. We have the fantastic Shayna Rittenberg on the show with us to talk about that a little bit later on.
Shayna Rittenberg is a dedicated neurology nurse practitioner with 14 years of experience and a nursing career spanning since 2006. Since 2021. She’s also served as a legal nurse consultant. Bringing her medical expertise to legal cases. Her combined clinical and legal knowledge allows her to provide valuable insights in both healthcare and litigation, and we are so happy to have her on the show.
For personalized consulting in care coordination and elder support planning, visit Northstar Care.
Shayna, welcome to the show.
Rittberg:
Thank you. Nice to be here.
How long is a resident considered as being in the process of admission?
Schenk:
Now I’ve had a few episodes dealing with medication errors in nursing homes and how they typically occur, but I’ve never had one focus exclusively on the. The process of admission, how we go from maybe acute care facility or maybe the home to a nursing home and that handoff and how medication errors can happen in that time.
So the kind of the first question, just to set the table for everybody is what are we talking about when we say the admission process or admission? What is that timeframe?
Rittberg:
Yeah, honestly, the admission process is right when the person walks through the door, and typically what I find is nursing homes allow about a 72 hour window for that.
I think it’s to give the staff time to get them acclimated and get everything done, but I really, the responsibility is right when the person walks through the door, honestly.
Review the latest research on the impact of preventive health measures in elderly populations.
Schenk:
What is the process and for the, so guys, for this question, let’s just assume that the resident is entering a nursing home from a hospital.
So what is typically the process by which the nursing home receives The prescriptions?
Rittberg:
Yeah. That’s the thing is that all the nursing homes have such a different process, but typically. What we’re seeing is that there’s a case manager involved and that there’s medication lists being sent to us, and some facilities in my experience have pharmacists on staff that will call other pharmacies to verify medications, especially if the patient is coming from the home.
But in hospital settings, what we see. More frequently is that a case manager is sending a list of medications from the inpatient, and I think that’s where the wires get a little bit crossed.
Learn more about findings on the role of staffing levels in nursing home quality and safety.
What are the most common medication errors during nursing home admissions?
Schenk:
So if I understand, so typically it’s typical, right? As you mentioned, the policies and procedures for all these nursing homes are different in terms of how they receive medication lists and prescriptions.
But typically is it going to be. A sheet of paper that gets given to the resident and the resident goes to the nursing home. Is it like via whatever the electronic medical records that the hospital has, they send it over to the nursing home typically. Like how is it physically, typically, how is it physically getting to the nursing home?
That prescription list?
Discover tips on how to find the right Georgia nursing home for your loved one.
Rittberg:
Honestly, it’s usually a piece of paper coming from either if the person is coming from a facility, it’s typically a piece of paper because a lot of the electronic health records don’t. Necessarily talk to one another. And I think that we take that for granted. If you work in a big facility and you have a high level electronic health record, you have that ability to cross-reference things.
But in nursing homes, they don’t always have the revenue to afford those high level electronic health systems. So they’re still documenting electronically, but their facility doesn’t have the ability to talk to the electronics. So what we see are pieces of paper and if they’re coming from the home. In my experience, we allow the residents to bring their medications.
We wanna see the bottles that they have. We tell them to bring their supplements as well. But if they’re coming from a hospital, especially, it’s a piece of paper.
Explore critical data on how structural deficiencies in long-term care settings affect patient outcomes.
Schenk:
So then I would imagine that the nursing home then would upload. Scan or just literally physically somebody’s physically typing that information into their own electronic medical record system.
Rittberg:
And then going from there, it’s typically entering the data manually. I the papers do get scanned in, but the medications also have to be manually entered so that now that facility, it’s can talk to one another, it can have. For nursing to see it, for pharmacy to see it. Anyone that’s involved can see it in that facility.
It has to be manually answered.
Understand infection management and care planning for the elderly in this study on long-term care facility treatment protocols.
Schenk:
Now we’ve talked a little bit about the actual, like the document that tells you the medications. What about the medications themselves? So if you still have, Ms. Johnson has a certain amount of antibiotics. That’s still being, administered every day.
How do those pills get to the nursing home, if at all? From the hospital or from the home?
Rittberg:
If they’re coming from the hospital, we make, we verify that we have that medication before we accept anybody because we don’t want any lapses in that medication. And if they’re coming from the home and we’re not like, that medication is not available to us, we’ll ask them to bring it with them.
Dive into research on how nursing facility structure and ownership influence outcomes.
Schenk:
And then I guess it’s the same thing. It gets inventoried once he makes it the most.
Rittberg:
Absolutely. It gets and it gets taken away from the resident. We hold that medication. Absolutely.
How does a skilled nursing facility’s structure impact medication safety?
Schenk:
So we have a piece of paper, we have bottles. They get inventory, they get uploaded into the nursing home’s own system.
And from my understanding, from what we’ve just described is that should happen typically within the first 72 hours. Yeah. Alright. Now we’ve set the table. Where are you seeing the most amount of problems and medication errors in that process?
Rittberg:
I think the two biggest things are missing a home med or entering in the wrong dose based on the way that it appears on the paper.
It looks like it’s one dose, but really it’s double that or it’s half of that. So we see medication errors from that. Definitely, I think the manual input. And also if they’re coming from home, forgetting one.
Learn how CMS tightened its nursing home rating criteria and what that means for families evaluating care facilities.
What role do nurses play in preventing medication errors during admission?
Schenk:
I see. So what is the what can the average nurse who’s, the one that’s admitting the resident, doing their first baseline baseline care plan, all that stuff, receiving the resident, what can they, he or she do to reduce those issues?
Hear how medication errors can occur in nursing homes and what families should know.
Rittberg:
I think it’s very difficult. For nursing in general, because especially if the facility is short staffed. But the best thing for them to do is if the resident has family, is to have a group conversation because. In my experience, the more people you involve in care, the more ears you have and someone will say, oh, but what about this and what about that?
And didn’t somebody give you this for that? And it’s more of a conversation. It’s impossible. I, and it’s hard because people take so much medication and. Just medicine alone is like a full-time job and it’s very difficult for us to expect people at, in their lowest time, in their sickest time to remember everything.
And so if the resident doesn’t remember that, they take it. Also, the nurses could ask them questions and it could just be a miss and or if the medication somehow didn’t make it to that piece of paper from the facility that they came from. There’s really, there’s nothing that you can do about it except try and make it better the next time.
But having open communication, especially if the resident has family, is like the best communication, the best way to talk to the people about it. I don’t know what else nurses can do. They’re already over, so over burdened.
If your loved one suffered harm from a medication mistake, speak with an Atlanta nursing home medication error lawyer.
Schenk:
You have a family in front of you and they’re admitting their loved one into a nursing home.
The loved one has, the 15, get the litany of medications. What are some of the things what would be a couple of things that you would recommend they do in order to minimize that medication error risk at the beginning.
Rittberg:
You mean to discuss it with the family so that the family can assist?
To help, honestly, I think having that open conversation, and even if you have the ability to get, make a list for the family or there’s a way to document what everything the resident is on. And just keeping open communication and asking them how they’re feeling, what they’re, what they’re doing in the facility on a day-to-day basis.
And not really making it just about medications, but if they’re on important medications obviously with my neurology background, I’m always thinking anti-epileptics. It’s like you have to really make sure that they’re getting their medications on a scheduled time. And just asking them to check in with their family members to see, to make sure, and if there’s an issue or a discrepancy, bringing it up with the staff.
Absolutely.
Read why it’s crucial to always check nursing home ratings before choosing a facility.
What process factors contribute to medication errors in nursing homes?
Schenk:
So I might’ve missed this and I apologize, but is there typically an individual if there’s no pharmacist on staff at the nursing home. Okay. Is there typically one position or title that is responsible for. Receiving the medication or receiving the medication list for every resident, or is it just shift by shift, somebody does something like that and facility by facility.
Learn about important red flags to look out for in nursing home admission documents.
Rittberg:
So I, I can almost guarantee that if you asked a hundred nurses that worked at nursing home how, what their process was it would almost. In my opinion, be different each time. And obviously you really want the nurse that is receiving that patient to take full control of what’s going on, but that is almost impossible.
To predict if that’s gonna be able to happen. And there are pharmacists at facilities and I think that is probably the best case scenario. But it is usually the nurses. It’s always the nurses that are responsible for it, and it’s a big job for them. It really is a big job to not only admit the patient, do the assessment, but then make sure that, especially if they’re coming from home and we need to keep their home medications to then make sure that they get into the appropriate place.
So that the next shift has access to them.
For help in medication-related neglect cases, contact a Georgia nursing home drug error attorney.
How can nursing homes improve medication management during admissions?
Schenk:
And you, I think you might’ve mentioned this before, but forgive me. The idea of verification. So you have a resident. That is being admitted from home and they hand you, the three or four bottles of pills or whatever, you’re not, the nursing home is not taking their word that this is the appropriate things for them.
Is there any type of verification process and if there is, what is it typically?
Rittberg:
Yeah, we look at the bottles and we verify with the pharmacy that these are recent medications and you know that the doctors that are prescribing them have recently put in this prescription for them. And if there are any discrepancies, we definitely it, that is a big responsibility.
You, you can’t just take someone’s word, you have to verify it in some way, shape, or form.
Stay informed about legislative updates like the new Georgia bill requiring better background checks for nursing homes.
How can families ensure their loved ones receive the correct medications?
Schenk:
And I guess when the resident is coming from the hospital and hands, the hands, the nurse. The admitting nurse, the prescription list that speaks for itself? Or is there still typically a verification process?
You’re still calling the pharmacies even though the person admitted from a hospital?
Rittberg:
No. If the person’s coming from a hospital, they’re, they’ve been on those medications, so we have to take their work. Like we have to just say this is what they’ve been on. Sure. And go from there.
Listen to our podcast on what to consider when placing loved ones in nursing homes.
Schenk:
Shayna we really very much appreciate you coming on the show and sharing your knowledge with us.
Rittberg:
Thank you. I really had a great time here.
Schenk:
Everybody, I hope that you found that episode educational Again, I apologize about the the audio. Hopefully Jean was able to clean that up, but I forgot to turn the mic on. That happens sometimes, even though I have a little cheat sheet of things that I need to do for every episode.
Every episode. To air is human. As they say. So if you have any ideas for topics that you would like for me to talk about, please let me know that. If you have any ideas for people that you want me to talk to, please let me know that as well. New episodes of the Nursing Home Abuse Podcast come out every Monday.
Please tell me that you want a coffee mug. I gotta get these things out of my house. So enter to win them. TikTok at justice for residents, that kind of thing. And with that, folks, with that pitiful plea, we’ll see you next time.
Shanna Rittberg’s Contact Information: