"Unsafe discharge planning"

As the Next of Kin of a patient recently discharged from your hospital via the Transit Lounge, I feel it relevant to bring all of the following to your attention.   

After spending a total of 3 weeks in hospitals my elderly parent was to be discharged from your hospital.  They were moved from their ward, 6 (either B or C where the care was exemplary) to the Transit Lounge where they sat and waited for around 6 hours before they were finally ready to be collected by their elderly spouse. Six whole hours of sitting and watching every other person who came into the transit lounge after you get discharged before you? Is that fair after three weeks of being an inpatient who could lay down in their bed whenever they needed, who could elevate their puffy, swollen, oozing legs whenever they needed? My parent was absolutely exhausted by the time they got home as was their spouse. Can St George Hospital please look into setting a time limit patients stay in the Transit Lounge? 

Their spouse is also elderly and together they live in a retirement village some distance from St George Hospital.  That day their spouse made three separate trips over to pick up my parent.  On the third trip they were successful. Their spouse made three trips because my parent had told them they was sure they would not be too much longer.  On each trip my parent's spouse parked their car a fair way from the hospital waiting for my parent to call them to drive closer and pick them up. It was cold and miserable on the day my parent came home. 

My concerns stem from my parent waiting for six hours to be educated about taking their Warfarin, which remains a relatively new drug for them.  According to the staff in the Transit Lounge that day there was nothing else they were waiting for.  The Pharmacist needed to speak with my parent to teach them about taking Warfarin.  I know this because I called the Transit Lounge.  By the time the Pharmacist got to my parent, they were over it.  They were tired and as I have said they were exhausted.  The information given to them at this stage was as good as none!   Obviously, there are major health risks when a person is prescribed this medicine, they need regular blood tests which determine how many milligrams of the drug should be taken as the next dose.  

So can anyone explain why my parent was sent home with 1 and 2 mg Warfarin tablets accompanied by the knowledge that a Respiratory Nurse would come to their apartment the next day to take their blood so the next dose of Warfarin could be calculated - yet when the Respiratory Nurse arrived, they had no pathology forms?    

This Saturday day was the beginning of a long weekend in Sydney and my parent was told there were no pathology request forms for their blood to be taken, but to take 3 mgs of Warfarin on the Saturday, Sunday and the Monday evenings.  Then on Tuesday, most likely, their blood would be collected.   

Because my parent was totally expecting the nurse to take their blood as they had been “educated” the day before, they were concerned and worried that their blood had not been taken.  The Respiratory Nurse took my parent's observations and basically said, see you Tuesday. My parent and I spoke with each other and, given this was Saturday morning, the beginning of a long weekend in Sydney, I was very concerned that they had been advised to take 3 mgs of Warfarin each evening.   

My parent had so much trouble getting off Heparin and onto Warfarin and these instructions simply did not sit well with me. So I made a large number of phone calls, indeed spending all of Saturday morning on the phone to my parent's Chemist, GP, doctors, the nurses; anyone really who would listen.  Eventually my parent's blood was taken and their INR results indicated that they did not need any Warfarin that evening.  My parent's bloods were taken on the Sunday and the Monday and they were advised not to take any Warfarin on either of these days as well. 

I am very grateful my parent did not take the extra 9mgs of Warfarin over the long weekend.  

For your information, the discharging Medical Officer had written my parent's scripts so they could take these to the local chemist and have them made up.  My parent uses a Webster pack and they knew they had taken Aspirin from their Webster packs previously.  They also knew that they were not supposed to take Aspirin whilst they were taking Warfarin. My parent had relayed to me the Warfarin bottles clearly said that.  

So why was there no notification to the Pharmacist that my parent was on Warfarin?  My parent's spouse took all of my parent's discharge scripts to their usual chemist where their new Webster pack was made up inclusive of the Aspirin.  For your information, my parent was reading from the Webster Pack that the Aspirin was a small, white, round tablet.  Indeed, it was not.  It was a small round orange tablet.  The Chemist had not changed the description of the Aspirin they packed into my parent's Webster pack.    When I spoke to the Pharmacist I was advised the word Warfarin was written onto one script amongst the handful of scripts my parent's spouse had taken to the local Chemist.  There was nothing else written.  The word Warfarin was on a page of another drug prescription.  So there was no prescription as such!  How is the Pharmacist supposed to know my parent was taking Warfarin?  They didn’t and I know they didn’t because I also spoke to them.   

I phoned the Chemist to advise them my parent was taking Warfarin and I wanted to check if they had made my parent's Webster packs with Aspirin.  Yes, they had.  I also asked if they knew my parent was now taking Warfarin.  No they did not.  Why would they?   

It was the Respiratory Nurses who saved the day for my parent.  Where would be without them?  They even came into my parents' apartment and looked into the Webster packs and identified the Aspirin tablet so my parent knew for sure which tablet not to take.  My parent has sustained a skin tear on one of their legs and is now wearing double tubigrips to both legs.  It was the Respiratory Nurse who gave them a dressing to go over the skin tear so it would not leak serous fluid into their tubigrip.  The Respiratory Nurses were brilliant, they still are as they continue to visit my parent at home.  

So given the litany of errors made regarding my parent's discharge from the Transit Lounge after a six hour wait I believe they are owed an apology.