"They've canceled my insulin. I've missed two doses now." As the nurse in the family, I am often the recipient of these types of phone calls from loved ones. This one was particularly concerning because the individual has Type 2 diabetes requiring insulin and had just been transferred from acute care to a short-stay rehabilitation unit.
It was time to sort out exactly what happened. Was this a misunderstanding, an oversight, or an outright error in management? Experience has taught me that just about anything is possible. The best approach is to not make assumptions and to calmly ask questions. In this case, the insulin formulation changed, but no one informed the patient of the new insulin name and dosing regimen at the new facility.
Transitions are embedded into the fabric of healthcare delivery. They occur at each shift change, when a new clinician or specialist enters the team, and even when patients return home or are moved to rehabilitation or long-term care. At each of these points, the healthcare team, patient, and family experience can change in ways that produce stress and uncertainty. At the same time, there is always the risk that something important will be overlooked, misunderstood, or missed altogether during the transition.
Transitions are especially stressful for patients who have medically complex diagnoses or care regimens. The patient or the family can often become the frontline experts in knowing how to successfully manage longstanding health issues at home. Once that individual moves into a healthcare setting, process changes such as the use of different products, discontinuation of established medication routines, and changes in medication times to meet institutional schedules, can disrupt an otherwise effective regimen and potentially produce undesirable outcomes, including disease or symptom exacerbation.
As a nurse intervening on behalf of a family member's request, knowing what questions to ask to resolve their concerns is easy. However, the tough part can be navigating how to reach the right people who can both provide answers and make decisions when necessary, especially in unfamiliar facilities. Otherwise, uncertainty prevails and is unsettling to all involved.
Effective communication between the healthcare team, patient, and family is the solution, but the rapid pace of modern healthcare systems makes pausing long enough to talk a challenge. Regularly asking, "What questions do you have?" and providing at least basic contact information for care team members would go a long way to establish an improved partnership, level of mutual understanding, and trust.
Until next time,
LINDA LASKOWSKI-JONES, MS, APRN, ACNS-BC, CEN, NEA-BC, FAWM, FAAN
EDITOR-IN-CHIEF, NURSING2023