D
Patient 1
(B)(4). PT WAS ADMITTED TO OUR HOSPITAL ON XX/XX/2016 FOR INDUCTION THERAPY FOR NEWLY DIAGNOSED SECONDARY ACUTE LEUKEMIA. SHE WAS STILL IN HOUSE ON XX/XX/2016. OUR COMPUTER SYSTEM IS SET SO THAT ALL MEDICATIONS WILL AUTO-DISCONTINUE AFTER 30 DAYS. AMONG OTHER ISSUES, SHE WAS POORLY CONTROLLED HYPERTENSION AND WAS TAKING MULTIPLE ANTIHYPERTENSIVES. ONE OF THESE IS CLONIDINE 0.3 MG TID. ON XX/XX/2016, THE CLONIDINE WAS DISCONTINUED AND NOT REORDERED. SHE ALSO WAS TAKING AMLODIPINE 10 MG DAILY, WHICH APPEARS TO ALSO HAVE BEEN DISCONTINUED AT THE SAME TIME. PT'S BLOOD PRESSURE WAS ELEVATED OVERNIGHT STARTING APPROX 12 HOURS AFTER CLONIDINE STOPPED (UP TO 185 SBP). UNCLEAR IF PROVIDERS OR RN'S REALIZED CLONIDINE AND AMLODIPINE WERE STOPPED. CLONIDINE RESTARTED ABOUT 24 HOURS AFTER STOPPED. AMLODIPINE NOT RESTARTED BUT NIFEDIPINE SUSTAINED RELEASED STARTED ALSO ABOUT 24 HOURS AFTER THE AMLODIPINE WAS STOPPED. PT DID DEVELOP BILATERAL SCLERAL HEMORRHAGES DURING THIS TIME FRAME - POTENTIALLY FROM THE HYPERTENSION. HER PLATELET COUNT IS APPROXIMATELY 50 AT THIS TIME. WE ARE STRUGGLING WITH THIS AUTOMATIC STATE DATE - THIS IS A NEW FUNCTIONALITY FOR US. WE INTEGRATED INTO A LARGER HEALTH CARE SYSTEM IN XXX 2015 - USING THE SAME EHR PLATFORM. WE DID NOT HAVE A AUTOMATIC STOP DATE PRIOR TO THE INTEGRATION SO ARE NOT REALLY LOOKING FOR THIS INFO - PHARMACISTS DON'T USE THE FUNCTIONALITY WHERE THE LIST OF "TO BE EXPIRING" MEDICATIONS SHOW UP. WE WOULD LIKE TO NOT HAVE THE 30 DAYS STOP DATE BUT GET PUSHBACK FROM CORPORATE COMPLIANCE DUE TO THEIR INTERPRETATION OF THE CMS 482.25 (B)(5). FROM WHAT WE CAN TELL, BOTH (B)(4) ARE NOT IN FAVOR OF AUTOMATIC STOP DATES. WE WOULD LOVE SOME ADVICE FROM YOU ON THIS MATTER OR YOU BRING IT TO A LARGER FORUM OF DISCUSSION. MEDICATION NOT ADMINISTERED TO OR USED BY THE PT.