Managing Medication History in Emergency Department

A 64 year old patient comes to ED with increased shortness of breath and a persistent cough in the last 4 days. Cough is productive with yellowish to greenish phlegm. Has a low grade fever of 37.8, heart rate 96, respiratory rate 24, SPO2 94% and BP133/91. Patient takes Adalat 30 mg daily for hypertension and has no known drug allergies. Electronic records confirm the prescription. Patient is triaged with a CTAS score of 3 by ED RN. After blood work and imaging of the chest, the patient is diagnosed with left lower lobe pneumonia. Patient is given an initial dose of Moxifloxacin 400mg IV and sent home with a prescription of Moxifloxacin (Avelox) 400mg orally daily for 4 days.

 The patient comes back in ED after completion of the course of Moxifloxacin. He is not getting better. His coughing and difficulty with breathing is worse than 5 days ago. His vital signs are as follows; Temperature 38.9, heart rate 110, respiratory rate 28, SPO2 89% at room air. CTAS on triage is 2. The ED RN asks the patient whether he is on any over the counter mediations, including vitamins and herbals. Patient states that he takes multivitamins with minerals orally daily with supper. This information was not shared on initial ED visit. The nurse, physician and the pharmacist did not know that the patient was taking multivitamins with minerals. Mineral supplements can keep the body from absorbing some drugs including Moxifloxacin. This implies that although the patient took all of the Moxifloxacin exactly as the physician ordered in ED, there was no resolution of the pneumonia as the body was not absorbing it.