Michael E Dubakey Medical Center Case Summary

MMCC, a Medicaid managed care organization, is located in the low-income community of Baltimore City. It is positioned across from a major medical center that does not provide its services. MMCC seeks to reduce their medical loss ratio (MLRs). As part of their strategy, they enroll poor people of the community through incentives, utilize a distant medical center to provide their services, and cut back on administrative requirements. To get communities members to enroll, they offer turkeys to enrollees during holiday times. They fail to inform members that they must use the medical center across the city and not the one directly across from their location. Once a member of MMCC, the patients experience poor quality care. Operators are limited and cannot keep up with calls to make appointments. Health care delivery site’s parking lot has limited parking spaces. The waiting room has limited seating. The actions of MMCC are legally and ethically questionable.

The divergence of goals and limited communication created a conflict between the physicians and the staff of hospital utilization review department. Although the physicians felt that the patient should remain hospitalized for some additional evaluation procedures, the decision taked by the utilization department was that the patient should be discharged because his condition did not rationalize continued admission. The physicians have the superior knowledge and the ability to take the right clinical decisions regarding the length of stay, while, the utilization review department serves as the oversight for approved length of stay and concerns the common clinical scenarios that lead to Medicare payment denials

Mr. Smotherman who was recently dismissed called, and he is concerned about the current medication that Dr. Green prescribed for him. His concern is if he stops it abruptly, are there any signs to look for or precautions he should take? Is it possible to refill meds for thirty days? He stated that he is currently seeking another physician for pain care. Thanks for your

Although Riverview Regional Medical Center faces numerous problems, it also has some strengths, weaknesses, opportunities and threats. RRMC Emergency and Cardiac Care departments are their strengths as they have been improved with new equipment to provide quality care to patients. The hospital should use marketing strategies to advertise their competitive quality care throughout the area and in other towns. Additionally, RRMC’s cardiovascular surgery program was rated number 1 in Alabama by HealthGrades.com website. Also, their orthopedics and stroke programs are well recognized. With modern facility and newer technology, RRMC has the capacity to grow.

Too much or too little medication taken away from instruction may have ineffective results of treatment. The patient should be discharged with both instructions of self-care and how to take medication. “The goal of treatment is to help the client maintain function and reduce inflammation before joints are permanently damaged” (Rosdahl and Kowalski, 2012, p. 1235). Interdisciplinary teams involved with the discharge of a patient can assist with taking the patient’s vital signs, transport, and assess their pain measures and reporting subjective and objective data to licensed personnel prior to leaving. If the patient has any last minute questions or concerns in detail of care, the interdisciplinary team can repot the patients

Dr. Wuo was in charge of answering any of the patients’ medication questions, as well as counseling the patients on the medications that they would take upon discharge. He would typically talk the patient through the directions of how they would take their new medications, followed by the common side effects that could possibly accompany the medications. This experience was especially insightful to me because I never have had the opportunity to work directly alongside a team of healthcare professionals, and it turned out to be a prime opportunity to experience interprofessional interactions and gain a better understanding for the pharmacists’ role on the team.

On this date worker visited Fresenius Medical Care, for the purpose of monitoring Mr. Smith’s situation. Worker learned during the visit Mr. Smith had missed several dialysis appointments 11/2 11/4 11/6. On 11/9 Mr. Smith arrived at dialysis with high potassium levels, he was admitted to the hospital for three days and received dialysis. The following week Mr. Smith received dialysis on Tuesday and Wednesday at the clinic. According to the dietician, Mr. Smith was given a pillbox and they assisted him with his medicine. However, they do not believe he is taking his medicine as directed due to his blood work showing some improvements but could be better.

When patients are seen in the clinic, I make every effort to review orders, labs, notes, and spend time with reconciling their medications, and clinical reminders. Medication compliance is a big issue seen in this clinic. For example, all veterans are asked to bring in all medication bottles to their visit. As a kidney failure patient, there are always a fluctuation in the patient’s lab values, which may result in change in their medications. Labs are drawn quite often due to the nature of one’s diagnosis. One thing that I found is, medications are adjusted due to lab results, it is noted a month or so after the veteran never increased the medication as directed. Couple of the veterans indicated they didn’t realize the dosages was different,

At Homestead Hospital ketorolac is used in women after childbirth for breakthrough moderate to serve pain. However, labs such as serum creatinine are not performed, while doctors’ orders indicate that ketorolac should be held if the patient is experience experiencing renal insufficiency. Patients experiencing renal insufficiency maybe be getting this nephrotoxic agent due to lack of lab work, leading to complications.

Telephone contact made to the patient. Two patient verifier completed. The patient states she started taking Hyzaar and Zantac approx 2 weeks. however, the patient states on this past Monday, Jan 11 two hours after she had taken her Zantac and Hyzaar her face, lips, and hands begin to swell and itch. The patient states that she took a Benadryl and used her Epi pen and that helped with her reaction. Due to her allergic reaction the patient states that she has stop taking the Hyzaar for her bp and the Zantac. Informed the patient that an appt with her provider is needed to discuss other bp treatment options and allergies. Apt was made. The patient instructed to monitor her bp twice a day, if she starts to feel dizzy, throbbing headahce, light

During the med check by the other pharmacy student, the patient informed us that he hasn’t been compliant with a couple of his medications which got me concerned. It made me think why he has stopped taking these medications and how this would impact him while on his health condition. Thinking back to my prior learning on medication noncompliance, patients who don’t take their medications

1202 patients were involved who usually need at least one prescription in a month.Among all order, the physician used, a handwritten prescription for two practice and computerized for another two method.Only 661 patient responded to the survey. 162 patients had adverse drug events, and just 51 patient condition was able to improve.Out of 51 improvable cases,32 incidents were because of physician’s failure to respond to medication-related symptoms and 19 were patient’s failure to inform the physicians on

Evidently, the medication administration is seriously delayed in this case. This is why. As soon as the doctor has finished his evaluation, and as soon as the new set of prescriptions has been generated,

MR is contingent upon obtaining an accurate medication list. This greatly affects the discharge medication list as omissions and inaccuracies will result in discrepancies, adverse events, and hospital readmissions (Super, Phillips, Coffey, & Patterson, 2014). Standardization in obtaining a detailed, accurate medication list is lacking in our institution. Many times multiple lists are obtained with conflicting medications. Patients cannot remember, are unsure of current medication lists, or simply have forgotten to bring

First goal: Patient will verbalize understanding of the importance of follow her heart medication regime as doctor prescribed it and describe the possible consequence of a non-compliance with her treatment by the end of her today’s appointment.