Page 65 - 2022 Risk Basics - Systems

SVMIC Risk Basics: Systems

19. Document the indication on the prescription and in the medical

record.

C A S E S T U DY

A 71-year-old male presented to the ER with chest pain and atrial
fibrillation. He had a cardiac workup, including a stress test and
trans-esophageal echocardiogram (TEE) and was prescribed an

anticoagulant as well as a loading dose of amiodarone. The usual

dosing strategy included a loading dose of 400mg three times per
day for one week and then tapering to a maintenance dose of 400mg
per day. Under pressure from the family for the patient to go home,

this patient was discharged by an internal medicine physician in the

cardiologist’s multi-specialty group who wrote a prescription for
the amiodarone exactly as it appeared in the patient’s medication
record that day in the hospital, which was 400mg three times per

day. The discharging physician later admitted in his deposition

that he never discussed the dose for the amiodarone prescription
with the cardiologist who had written the inpatient orders. After the
patient was discharged, a copy of the hospital discharge summary,

which included the medications and dosages that were prescribed

for the patient to take at home, was sent to the cardiologist as well
as the primary care provider.

The patient returned to the cardiologist’s office one month later,
and the nurse incorrectly documented the Amiodarone dosage as

200mg two times per day. At that office visit, the patient complained
of shortness of breath and dizziness.

The patient returned to his cardiologist’s office two times over the

next two months. At each visit, the patient was asked if he was on

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