While working on a Saturday afternoon, our nurse Christine Puskar received a phone call from the family member of a patient whom she had discharged the day before. The patient had been sent home on prescription Nexium and when she was attempting to fill the prescription, the family member discovered that the co-pay for this drug was going to be $500. Throughout the course of the conversation, Christine discovered that the patient's prescription for 100 mg of Spironolactone also had a very high co-pay. The family was at her local pharmacy and Christine asked to speak to the pharmacist for clarification. While on the phone with the pharmacist, Christine pulled up the list of $4 medications and discovered that 50 mg Spironolactone was on the list. She learned from the pharmacist that the prescribed strength of Nexium could be obtained by taking a higher dose of over the counter Nexium.

Armed with that information, Christine then located the physician who had discharged the patient and had a discussion with him. While he initially pushed back about changing the way the medications were prescribed, once he understood that the patient would be unable to fill her prescriptions at all without the dosage adjustment, he became agreeable to calling in a modification to the prescriptions. Christine next called the patient's family to explain in detail the changes to the prescriptions. She provided detailed instructions about how they would take the medications, and reinforced that the medications were on the $4 Rx list. Christine went on to emphasize the importance of taking these pills, and that not filling them would likely result in a return trip to the hospital. The family agreed that they would pay for the prescriptions when organized the way Christine had worked it out for them. Christine then went the final step and called the pharmacist to personally discuss the changes to the prescriptions, and explain why we made the modifications.

I was so extremely impressed by Christine's advocacy for her patient. She went above and beyond her role in ensuring that her patient would be successful post-hospitalization. With the knowledge she had, she orchestrated a solution to what could have been a potential deal-breaker for this patient's recovery.

Christine's actions that day likely prevented a re-hospitalization for her patient, and certainly demonstrated MUSC Excellence.