How to navigate Transitions of Care

Dr. Louise Achey, Doctor of Pharmacy
My stepmother is going to have her hip replaced next week. After the surgery, she will wake up in a recovery room and possibly stay overnight in the hospital. Afterward, she’ll be discharged directly back to her home or to a skilled nursing facility (AKA a nursing home) for several weeks of strengthening therapy, called rehab.
Each time she moves from one health care setting to another, her doctors and nurses must communicate any vital information about her to the next person. Each time she moves from one care setting to another is called a Transition of Care.
Medical care is a lot like a relay race. When the nurse or doctor taking care of you goes off shift, another transition of care occurs, from them to the medical professional coming on shift. This “handoff” is where important information about you can easily get lost, leading to potentially serious problems.
That’s what happened to Emma. My friend Sherry accepted the responsibility of being her widowed elderly aunt Emma’s medical power of attorney, or POA. Emma fell the first week of January, breaking her hip, which required surgery and several weeks of rehabilitation at a local nursing home. 
Emma received her first COVID vaccine while a resident of that nursing facility, then discharged back to her own home before it was time for her booster. 
Sherry called me yesterday morning and asked, “How do I get Emma her booster shot of COVID vaccine? The nursing home says she’ll have to go somewhere else.”
I called the nursing facility to find out who gave her the initial COVID vaccine. They explained the vaccines were given by CVS, a pharmacy chain with a federal contract to immunize nursing home residents. CVS came and gave every resident their first COVID vaccination. They supposedly contacted anyone who had been discharged to register them for the booster. The company had just finished its last booster clinic the day before.
There are no CVS pharmacies in our area. I asked the nursing home for contact information to find out if CVS would be in any other nursing facilities in our area. Unfortunately, when I called them, no one could connect me with whomever was administering the COVID vaccine. They couldn’t even tell me who I could contact to find out more. It was like CVS swooped into town, gave the vaccine to those nursing home residents, then left without a trace.
When I asked for a copy of Emma’s COVID vaccine card, the nursing home said they didn’t have it anymore. They explained that it had been mailed to Emma’s POA. Unfortunately, my friend never received it, so we recreated one from the nursing home records on a blank COVID vaccine card, documenting the date, manufacturer, and site where Emma received her COVID vaccine. 
Although Emma received the Pfizer COVID vaccine, our local pharmacies only have the Moderna vaccine. Is it okay if Emma gets a Moderna booster? 
Yes. The Centers for Disease Control and Prevention (CDC) states that if someone residing in an assisted living or a nursing facility has moved, it is okay to get a booster with the Moderna vaccine even if the initial vaccine dose was from Pfizer and vice versa. Since they are both mRNA vaccines, the CDC states that it is acceptable. 
The CDC now states you can delay getting the booster beyond the 3 weeks recommended by the manufacturer for the Pfizer COVID vaccine or the 4-week booster recommended for the Moderna vaccine. Up to 6 weeks is considered acceptable, especially in light of the recent weather-related delays in shipping the vaccines.
Here are 4 ways to protect yourself or loved one 
during Transitions of Care
1. Make a current list of all your medications, and keep it updated.
This is especially important when coming home from the hospital or nursing home. There may be changes or duplications during the time you or your loved one have been away.
2. Bring your discharge summary paperwork to your next medical appointment.
Doctor’s offices are not always kept informed of what happens to you during a recent hospitalization. Bringing the latest information with you helps to keep everyone in the loop. 
3. Ask.
With COVID restrictions making face-to-face discussions rare, misunderstandings are commonplace. Medical providers stretched for time and may not take the time to explain the plan of care. 
4.Be a Squeaky Wheel.
Speak up whenever something doesn’t seem right to you. You may be the only one who notices an omission or discrepancy. 
Dr. Louise Achey, Doctor of Pharmacy, is a 40-year veteran of pharmacology and author of Why Dogs Can’t Eat Chocolate: How Medicines Work and How You Can Take Them Safely. Get clear answers to your medication questions at her website and blog ®2021 Louise Achey


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