Yesterday I did an transition care (TCU) admission visit on a 76 year old lady post- op day 5 after a somewhat complicated cervical spinal fusion post- MVA. On her medication list was: prn hydroxyzine (for pain or anxiety per med list), prn cyclobenzaprine, and prn diphenhydramine. She was on a low dose of scheduled gabapentin. Her pain med order: 1 mg of hydromorphone every 6 hours as needed. To my hospital colleagues: please don’t send elderly people to the TCUs with these kinds of prns. You don’t know what caliber of nurses or what kind of staffing ratios that the TCUs have. It isn’t like the hospital.Any of these prns on top of her pain meds and scheduled meds could make a LOL (little old lady) get up at the unfamiliar TCU, feel loopy and fall and break a hip- happens all the time. A simpler med list is better! For this patient, I increased the opiod slightly due to pain, and discontinued everything else listed, and she is doing great.
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