Lecture Notes: Issues in Medication Management and Patient Care

Overview of Pectus Excavatum

• Condition: Congenital condition where sternum grows abnormally, creating a concave chest appearance.
• Prevalence: 1 in 200 to 1 in 400 children.
• Treatment: New minimally invasive and safe procedure available.

Case Study: Lewis's Hospital Experience

Initial Conditions and Surgery

• Hydration Issue: Entered hospital dehydrated, not producing urine.
• Fluid Management Error: Inappropriate low IV drip prescribed, meant for small child rather than a 15-year-old.
• Resolution: Change initiated by knowledgeable nurse and pharmacist.

Pain Management Complications

• Medication: Epidural with hydromorphone and Pivacaine; adjunct medication IV Cotorilac (Toradol) every six hours.
• Issues: High narcotic levels dangerous for opiate-naive patient, Cotorilac ineffective for pain.

Post-Surgery Deterioration

• Symptoms: Sweating, itching, nausea, no food intake.
• Misdiagnosis: Constipation from narcotics dismissed other evidence.

Decline to Critical Condition

• Deterioration: Over 30 hours, developed sepsis, shock, and severe dehydration.
• Vital Signs Check: No blood pressure detected; multiple failed attempts to draw blood.
• Cardiac Arrest: Sudden cardiac arrest, leading to death.

Impact on Family

• Personal Effect: Significant emotional toll on family and daughter.
• Long-term Impact: Persistent sadness at family milestones.

Analysis of Medical Errors

Systemic Issues

• Guidelines and Protocols: Inflexible application without considering individual patient needs.
• Provider Responsibility: Need for caregivers to personalize treatment and investigate symptom-medication correlation.

Medication Safety Concerns

• Disrespect for Medication Power: Underestimation of harm potential from medications by providers and patients.

Complexities in Pain Management

• Challenges: Complex systems due to patient, disease, dispensing, and regulatory issues.
• Patient Compliance: Reluctance to discuss and manage pain effectively.

Medication Management in Hospitals

• Multi-Professional Responsibility: Not only a pharmacy responsibility; involves all healthcare staff.
• Process Phases: Includes planning, prescription, preparation, dispensing, administration, and monitoring.
• Error Prevention: Identifying risk points and implementing strategies to prevent errors.