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CALLER: Hello Ms. Smith, I am Brian, a nurse from [Hospital]. When you left the hospital, Lynn, your discharge educator, mentioned you'd receive a call checking in on things and I'm glad to help with this call. I am hoping to talk to you about your medical issues, see how you are doing, and see if there is anything I can do to help you.
PATIENT: How nice to hear from you.
CALLER: Do you mind if I ask you a few questions so I can see if there is anything I can help you with?
CALLER: Is this a good time to talk?
CALLER: It will probably take about 15 to 20 minutes, depending on the number of medicines you are taking.
PATIENT: That's o.k., it might help as I want to do the best I can to get better. Did you know my granddaughter is getting married this year? She is just the love of my life.
CALLER: Before you left the hospital, Lynn, the discharge educator spoke to you about your main problem during your hospital stay. Using your own words, can you explain to me what your main problem or diagnosis is?
PATIENT: Yes, I was admitted with congestive heart failure. It was the second time this year.
CALLER: Could you tell me your understanding of congestive heart failure?
PATIENT: It means my heart isn't pumping blood as good as it used to.
CALLER: What did the medical team tell you to watch out for to make sure you're o.k.?
PATIENT: Yes, they told me to take my medicine, weigh myself daily, eat a low-fat and low-salt diet... and if my weight increases by 2 pounds compared to what it was when I left the hospital then call the nurse in my doctor's office.
CALLER: Have you been able to do those things?
PATIENT: Yes, I try to stick to it as best I can, except at Easter when I always have ham. But my weight is 142, 2 pounds more than when I left the hospital.
CALLER: Have you called and told your doctor's office that?
PATIENT: Not yet, but I should, shouldn't I?
CALLER: Yes, I will remind you before we get off the phone. Since you left the hospital, do you feel your congestive heart failure has improved, worsened, or not changed?
PATIENT: I think I am about the same.
CALLER: What does your family think?
PATIENT: My son tells me I look much better than when I was in the hospital! He says I've been breathing easier too.
CALLER: Have any new medical problems come up since you left the hospital?
PATIENT: No, I don't think so.
CALLER: Can you bring all of your medicines to the phone, please? I'd like you to bring everything you are taking, even medicine that you get without a prescription, including vitamins, supplements, herbal remedies—everything. We will review them during this call. And can you also please bring the care plan you got before leaving the hospital?
PATIENT: O.k., give me a minute.
CALLER: Do you have all of your medicines in front of you now?
PATIENT: Yes, I have them now.
CALLER: I'm going to ask you a few questions about each one of your medicines to see if there is anything I can help you with. We will go through your medicines one by one.
First of all, I want to make sure that the medicines you were given were the right ones. Then we'll discuss how often you've been able to take them and any problems or questions you might have about any of them. Is that o.k.?
CALLER: Choose one of your medications to start with.
PATIENT: This one is my small white pill. Do you know it? I have taken it for a long time, but now the name is different.
CALLER: What is the name of this medication? The name should be on the label.
PATIENT: FUR-O-SI-MIDE. That is hard for me to say. I used to take something that looked just like this called Lasix.
CALLER: Yes, furosimide and Lasix are the same thing.
PATIENT: That is confusing!
CALLER: Yes, it can be very confusing for people. What is the strength of the medication? It should say a number and a unit, such as mg, mcg, etc.
PATIENT: 20 mg.
CALLER: How do you take this medicine? And at what times during the day?
PATIENT: I take it in the morning because it causes me to pee a lot, but not so much lately.
CALLER: You take it only in the morning?
CALLER: And how many pills do you take in the morning?
CALLER: I notice here in the records that the doctors in the hospital increased your medicine so that you are supposed to take one pill in the morning and another in the evening. Were you aware of that?
PATIENT: No, it was really rushed when I left the hospital. A nurse gave me a form to sign that has my medicines on it but I can't understand it. So, I'm taking what I took before I went to the hospital, the ones my doctor told me to take.
CALLER: Do you know the reason you are taking Lasix?
PATIENT: I know it makes me pee.
CALLER: Yes, it helps you to remove the extra fluid from your lungs. Are you o.k. with taking a second pill in the evening until you see your doctor next week?
PATIENT: I'd rather not, because I don't like having to get up at night to pee.
CALLER: For right now it's really important that you take that second pill in the evening to keep the fluid from building up in your lungs. You can talk with your doctor when you see her about cutting back, but for now we really need you to take a second pill in the evening. How about if you take it at 6 p.m.?
PATIENT: I guess I can do that.
CALLER: So tell me, how are you going to take your Lasix tomorrow?
PATIENT: I'll take one when I first get up, and one after dinner, around 5:30 or 6 p.m.
CALLER: That sounds great.
[ALL MEDS ARE REVIEWED AND IT WAS ALSO DISCOVERED THAT THE ASPIRIN THAT SHE IS SUPPOSED TO TAKE WAS LEFT OFF HER DISCHARGE LIST. SHE AGREES TO BEGIN TAKING IT.]
CALLER: Have you been using the calendar in your care plan that was given to you when you left the hospital?
PATIENT: Yes, I love it. It helps me a lot to keep track of my appointments.
CALLER: Now, I'm going to make sure you and I have the same information about your appointments and tests that are coming up. You were given appointments with your doctors and for lab tests when you left the hospital. Can you please tell me what appointments you have scheduled?
PATIENT: Yes, I have an appointment with my cardiologist next Tuesday at 3 p.m. in his office on Main Street.
CALLER: Great. How are you going to get there?
PATIENT: My sister is going to take me. She has an appointment in the same building that afternoon.
CALLER: And what about the appointment at the lab to have your Coumadin checked? Did you keep that appointment?
PATIENT: Oh yeah, my son has been out of work and just got a job so he couldn't take me that day.
CALLER: Let's talk about how we can work around these difficulties. Would it be o.k. if I called the home care service and asked if they could go to your house to draw your blood?
PATIENT: That would be wonderful. You are so nice.
CALLER: O.k., Mrs. Smith, those are all the questions I had for you. What questions do you have for me?
PATIENT: You know, I think you answered all my questions, even ones I didn't know I had! I could've ended up in the hospital again if it weren't for this call. [Hospital] provides wonderful care, don't they? It seems as if they really care about me.
CALLER: Thank you so much for your time, Mrs. Smith, take care.