A veteran with a history of DVT and HTN was transferred from Belton Regional Medical Center to Research Medical Center, where he was discharged to a skilled nursing facility and then to Home Health. The Home Health nurse contacted the PACT team for medication reconciliation. Her specific question was whether the patient should be taking propranolol and primidone, two meds he was on prior to hospitalization. The home health nurse did not have hospital discharge paperwork and was trying to reconcile the patient’s pre-hospitalization medications with the medication list she had received from SNF. The patient was taking a mix of previous medications and new medications from the discharge list, including apixaban. 

Abigail was able to address the Home Health nurse’s question through a review of the discharge summary and a discussion with the covering PCP. But instead of just focusing on answering that specific question, Abigail kept the whole picture in mind. While reviewing 295 pages of documents from the veteran’s hospitalization, Abigail found that while hospitalized, the patient had been diagnosed with hypovolemic shock due to an acute upper GI bleed. He had an actively bleeding vessel and was unsuccessful in achieving homeostasis. The veteran underwent an arteriogram with coiling of the artery. His apixaban was stopped, and an IVC filter was placed for the history of DVT. Per the hospital provider's notes, “His Eliquis will continue to be held due to the life-threatening nature of the bleed.” 

Abigail alerted the covering provider and notified the Home Health nurse and patient to immediately discontinue the apixaban. As a float RN, Abigail did not know this patient or his history, but she was diligent and thorough in reviewing the entire history of his hospitalization and did not settle for a quick, easy answer to the question at hand. It was a great catch, and patient safety was preserved!