Top Tips for a Trip to the Emergency Room: What You Should Know Before an Emergency Happens

Emergencies—they’re unplanned, crisis situations, and although you never know when one will occur, it’s important to know what can happen during an emergency room visit. Although your medical providers may give you adequate care in getting you stabilized—are you certain you’ll have all the information you’ll need after being discharged from the emergency room and going home?

In this series, we’re going to analyze the case of a patient who had an accident, and in each segment, we’ll focus on one area of his care, and tell you what should have been done better by the hospital staff. Now, we know many of you will be saying… “Well shouldn’t the hospital know what to do?” The answer is “yes,” you’re correct they should, but unfortunately often times there are important elements of care that are “left out”, or “forgotten” by health care professionals, so we’ll share tips that you can use to make sure that you know what questions to ask if you or a loved one is ever taken to the emergency room, and you’ll learn from what this hospital did right, and also see what they did wrong.

 emergencyroomtips Emergency Room Case Study # 1:  Motor Vehicle Vs Motorcycle Rider

Just last week a 60+ year old man was hit by a motor vehicle while riding his motorcycle on a very busy, well traveled two lane highway. The man was wearing a helmet, but was struck by the car and was taken to the emergency room by EMS for treatment and evaluation.

Once at the emergency room, the man was evaluated, treated and released back to his home. Although there wasn’t anything inherently wrong in the care that the man received at the emergency room, there were some procedural omissions that could have caused the patient to have complications not only from some of the prescriptions given, but from the actual injuries themselves.  Here’s what happened, and we’ll outline the things that the Texas Hospital Emergency Room staff could have done better.

With three broken ribs, and lacerations over a large part of his body, this patient’s medical concerns after discharge from the hospital involved pain control, prevention of infection, and prevention of pneumonia. 

In today’s segment, we’re going to start with the issue of pain control:

1. Pain Control:  The patient received pre-printed instructions from the emergency room regarding the medication that he was prescribed:

Acetaminophen-hydrocodone (Norco 325 mg 5mg) oral tablets were listed as prescription medications on the discharge sheet. However there were glaring omissions on the instruction form:

There were at least three (3) errors or omissions made by the hospital staff with regards to the pain medication and patient education of the patient:

Nowhere on the 7 sheets of information provided by the hospital staff did it mention that the narcotic pain medication that he was prescribed should be  taken with food. 

Remember, this patient had just suffered a traumatic injury to almost all areas of his exposed body, not to mention the broken ribs which were broken in the back and were some of the larger ribs which can can cause excruciating pain.   Furthermore, the patient’s spouse was out of town at the time of the accident, so he was basically in the emergency room alone and without an advocate with him.  The patient says that the hospital staff never discussed how to take his prescriptions, and instructions for the narcotic pain reliever were nowhere to be seen on the discharge form.

The hospital staff should have absolutely not only verbally explained the importance of taking the medication with food, but this information should have been printed on the discharge documentation that was provided to the patient. Remember, when you or someone you love is in pain and has just suffered a trauma, it is important for someone verbally to instruct you on what to do, and to also put important instructions in writing for the patient to review after the initial trauma has passed.

The 2nd omission from the hospital staff is that no one explained how the pain cycle works. And how important it is to “stay ahead of the pain”.  So the patient when discharged home, and without any family members with him to monitor him didn’t know that he should at least at first, take his medication regularly on schedule instead of waiting until it was past time to take his medicine for pain.

And the 3rd omission from the hospital was that no one had explained that it was ok for the patient to use Ibuprofen in between the narcotic pain medication dosages. Although the discharge sheet said that the patient could use “Tylenol or ibuprofen” for pain, the pre-printed form did not give instructions on how to use these drugs, and then it had a disclaimer that they could only be used if the “caregiver has not given medications that interfere.”

That’s not good enough…the patient doesn’t know if his prescribed medication will interfere. In this day and age of computerization, it’s simple enough to build in an algorithm into the computer system that says since this patient was given a prescription medication that contained Tylenol, then the Tylenol should not be listed on the discharge form as an option. But the non prescription ibuprofen could have remained as an option on the discharge form but only if it were clearly explained the manner in which the ibuprofen could be used along with some information about “not to exceed” so many mg per 24 hour period with ibuprofen, and again, a warning to take such medication with food. And finally, the patient should have been told that it was ok for him to take the Ibuprofen a few hours after taking the prescription pain medication.

Using ibuprofen along with narcotic pain relievers especially in a motor vehicle accident can be therapeutic, because the ibuprofen will reduce the swelling and inflammation from damaged tissues, while the narcotic pain reliever simply relieves pain.

When we intervened in this case, the patient was not getting adequate pain relief because he was simply taking the narcotic pain reliever and was not using Ibuprofen as an adjunct in between dosages. When doctor’s or nurses fail to provide complete information about pain control, the patient suffers.

One good resource to use if you are wondering about safety of certain pain medications with over the counter medications or those you are currently taking is your local pharmacist. Pharmacists, if they have your entire prescription history, can guide you on any safety concerns on medications and can also help with providing information on how to safely combine over the counter medications such as Ibuprofen to relieve swelling and inflammation after an injury with whatever other medications you have been prescribed. It is never ok to simply add medications either over the counter or prescribed without checking with your doctor and/or pharmacists.

 

Summary: Quick Hospital Emergency Room Tips For YOU to Print out and Use

A: If a pain mediation or other medication is prescribed ask if the medication needs to be taken with food/milk or if there are certain foods to avoid when taking the prescribed medication

B: If you are prescribed a medication for pain: ask while you’re in the ER what over the counter medications could be used to supplement your prescribed pain medication.

**** IF using an over the counter medication as a supplement for pain control or otherwise, make sure you ASK what the maximum amount to be taken is for a 24 hour period and do not exceed that amount.

Certain medications can be harmful to the liver or even deadly (even over the counter medications) so it is important to ask these questions and to follow your doctor’s instructions carefully.

C: Have a medication log: noting exactly what date/time/type of medicine you took and your reaction to it  so that you can see how effective your medication is

D: Ask your nurse how to “stay ahead of the pain”. If you wait too long to take your next scheduled dose especially early on in a trauma injury, you could actually be setting up a scenario  where you will have to take more medication than you would have normally needed to take ie: (if your prescription says 1-2 pills) and you’ve let your pain escalate too high, you may have to take 2 pills whereas if you had stayed on track with taking your medication as prescribed for example, every four hours or whatever your prescription says, then you may be able to manage your pain with only one tablet.

Since in many cases the patient in an emergency room visit may be too injured to remember all the details, it is always a good idea to have someone with you on every emergency room visit. Even if you have to call a friend to meet you at the hospital or ask the hospital staff to call someone on your behalf, always have an advocate at the hospital with you, and print out these tips, so that you’ll know what to do in the event of an emergency.