Pharmacy technician Marjorie Grant was working a normal shift in the ER pulling medication histories, when she got called to a patient’s bedside. The woman came into Gerald Champion Regional Medical Center in Alamogordo, NM, holding her head in pain, feeling nauseous and faint.
A nurse indicated that the woman had her medications in her overnight bag, so Grant began collecting her medication history by introducing herself, explaining what her job was, and asking for permission to look inside her bag.
“The bag was in total disarray, with some of her meds in bottles and some in bags, all with different directions, and most filled within a week of each other,” recalls Grant. “Most alarming to me, she had three versions of one drug, both extended release (ER) and delayed release (DR), and three full bottles of each. One newer prescription was supposed to be taken three times a day and the older med two times a day.”
The patient, who has cerebral palsy and diminished capacity, admitted that she was confused about which medications she was supposed to take and when. Grant reassured her patient that she would get things straightened out.
Untangling the mess
First, Grant called the CVS pharmacy listed on the bottles and asked to speak to the pharmacist to obtain a fax of the patient’s prescription history, and information on the prescribing physicians. For unexplained reasons, the CVS system had not red-flagged that the patient’s auto-refill and new prescription would interact poorly or that the woman would be overmedicated by having so many prescriptions filled within a week.
Next, she called both the primary care physician and the neurologist to alert them to the conflicting prescriptions and set about determining what the doctors felt was the right medication and dosing. She also made sure the pharmacy took the right drugs off auto-refill and flagged the patient’s file to note that she needed extra counseling when prescription changes occur.
After getting approval from the doctors involved, Grant organized the patient’s correct medications in new bags with labels that the patient understood, explaining which meds were for pain and which ones were for seizures. She also described all the changes to the woman, who was panicking and scared, in language that she understood.
The patient was afraid she had done something wrong and would get in trouble for coming to the ER, but Grant reassured her that she’d done the right thing in seeking help when she didn’t feel well. Grant also spoke to the woman’s family in California to make sure they understood what was going on. The hospital received a thank you note shortly after this event, calling out Grant’s efforts.
When experience counts
What gave Marjorie Grant the moxie and knowledge to recognize the problem before her and handle it so well? She says it’s her diverse work experience, her efforts to learn about drugs, and lack of fear when it comes to talking to doctors.
“Over the years, I’ve learned now to look at a patient’s meds, to notice the date they were filled, whether they’re expired, or if old meds have been mixed in the bottle with newer meds,” says Grant. “I make it a point to know my meds, so in this case, I knew that the ER and DR versions were not interchangeable, and that this patient was probably dangerously overmedicated.”
Grant has worked almost 20 years as a pharmacy tech. She served as a corpsman in the U.S. Navy, and worked as a certified nurse assistant, pharmacy retail at CVS, and mail order at Humana. She brought all of that experience to her role in the ER at Gerald Champion Regional Medical Center almost five years ago.
“I feel it’s important to have a pharmacy tech in the ER,” says Grant. “We can be a true asset if we have enough experience and know our meds. It’s a beautiful job and we can save a lot of patients.”
She appreciates the occasional thank you’s, flowers and other gifts that patients bring after similar interactions, but what delighted her most was when a young man came in and told her that she’s known at the nearby gas station for going above and beyond for ER patients.