Dialogue Volume 14 Issue 4 2018 - Page 41

PRACTICE PARTNER department (ED) at Hospital A. He was re-admitted with acute renal failure and thrombocytopenia. Between July 28 and July 29, his condition worsened, with in- creased epistaxis and hypertension. On July 29, he was found unresponsive and a CT scan of his head revealed exten- sive left-sided subarachnoid hemorrhage with midline shift and cerebral edema. He was transferred to the intensive care unit (ICU). Later that day, he was transferred to Hospital B where he was seen by neuro- surgery and determined that he was not a candidate for surgery. He was treated with platelet transfusion and IV steroids and then started on dialysis. On July 30, his neurological condition continued to dete- riorate and life support was withdrawn. He was pronounced dead later that day. The medical cause of death was deter- mined to be intracerebral hemorrhage secondary to thrombocytopenia complicat- ing vancomycin therapy for the treatment of diabetic foot ulceration. The PSRC’s report focused its review on issues associated with the discharge from Hospital A, in particular the transition process from hospital to home and manage- ment of vancomycin administration and monitoring in the community. “There was no clear plan for vancomycin monitoring and dosing adjustment after dis- charge from Hospital A, including defined roles and responsibilities for the various care providers in the community (e.g., both van- comycin and serum creatinine levels should have been checked),” stated the report. After discharge from Hospital A, CCAC was involved in coordinating care for the patient. Attempts were made to arrange for a vancomycin trough level to be done on Friday, July 26. This did not happen due to administrative issues, including an incor- rect fax number to obtain the correct signed requisition from the ordering physician. In records reviewed from Hospi- tal A, there was no clear identifica- tion of a requirement for moni- toring of vancomycin levels and plans for dosing adjustments on Care in the discharge. In hospitals, monitoring of vancomycin levels is typically community is looked after by pharmacists. In this complex and case, it appears that the CCAC and requires clear the pharmacy service provider did not have a standardized protocol communication for the monitoring of vancomycin. protocols This case highlights a number of potential vulnerabilities associated with providing medication manage- ment services in the community, stated the committee. “It is highly relevant as Ontario moves to increase both the number of patients cared for in their own homes and the complexity of the care provided in the home setting. Hospitals, CCACs, primary care providers and phar- macy service providers must work together to develop reliable systems to ensure that patients being discharged can be appropri- ately and safely cared for in the home setting and that rapid intervention is available if their clinical condition deteriorates,” the report stated. ISSUE 4, 2018 DIALOGUE 41