Grady Hospital Interdisciplinary Staff Workshop
Care Transitions Case Discussion
Care Transitions Role Play Exercise- Pharmacy
Ms Brown is an 84 yr old female with a history of diabetes, hypertension, atrial fibrillation and hyperthyroidism recently admitted for pneumonia. Her hospital course was complicated by several hazards of hospitalization including delirium, restraints, deconditioning resulting in a fall. Ms Brown has improved and is to be discharged home. You have been asked to provide medication education to Ms Brown and have been informed that Ms Brown is ready to be discharged. You walk into the room to discharge her and you notice that while providing her with her medication education, she appears a little confused. You observe that she is oriented to place and person but not to time. You however begin to discuss her medications with her, but she still seems confused about her medications. You observe that she has just been started on insulin during her hospital satay and this is one of her discharge medications. She is also on Coumadin for her atrial fibrillation. She requests for assistance to use the bathroom and in assisting her, you observe that she has great difficulty walking. You ask her to sit down and obtain a walker for her, and assist her to the bathroom. You ask her about her caregiver and she informs you that she has none and lives alone.
Task
- What will your next step be? With your partner discuss your next step.
- Since the physician thinks that she is doing better clinically, do you feel that it is safe to send Ms Brown home?
- Do you have concerns about her medication management capacity? What steps would you like to take to promote her safety at home?
- Role play as the pharmacist while your partner role plays as the physician – communicate your findings to the physician and suggest some possible next action steps.