Obtaining an accurate medications list from a patient can be a painstaking endeavor with dubious payoff.
Experts advise tapping into multiple sources of information, including the patient’s pharmacy, their physicians, and family members. Also, interview questions should be scripted to include prompts that maximize recall. Obtaining histories from older adults – 17 to 19 percent of whom are taking 10 or more different types of medications in a given week1– presents a unique challenge. Additionally, patients with low health literacy and those with cognitive impairment require the help and input of family and caregivers.
Make It Meaningful:
Inform patients and their families that obtaining an accurate and complete medications list is essential to safely prescribing medications while the patient is in the hospital. Explain that obtaining an accurate list ensures that the medications the patient needs will be ordered and that those that might cause harmful interactions won’t.
But It’s Natural!:
While health care professionals are well aware of harmful interactions that occur when prescription medications interact with supplements, OTCs, and herbal preparations, your average patient may not volunteer this information, regarding all substances of this type as “healthy” or “harmless.” When interviewing, ask about prescription medications as well as over–the-counter medications, supplements, vitamins, herbal preparations, and nutraceuticals.
Digging Deeper–Uncovering
Nonadherence:
Just because it’s on the list, doesn’t mean the patient is taking his or her medication or taking it as he or she should. It’s important to not only ask if they’re taking it, but how they’re taking their medication. Polypharmacy, inconvenient scheduling, prolonged duration of therapy, excessive cost, unpleasant side effects, low health literacy, and simple forgetfulness are but a few causes of patient nonadherence. Estimates of medication nonadherence typically range from 30 to 60 percent, with nonadherence being greatest for patients who are symptom free.
Ask and Then Ask Again! Trigger Recall by Rephrasing the Question:
- Ask about doctors – Asking about a particular doctor may trigger patient recall: “What medications does your kidney doctor prescribe? What about your heart doctor?”
- Ask about diagnoses – Reviewing a problem list can offer insight into medications: “Are you currently taking any medication for your heart condition? For your arthritis?”
- Ask about frequency – Patients often forget to include medications with infrequent dosing: “Are there any medications that you take daily, weekly, or monthly?”
- Ask about route – In addition to inquiring about oral medications, ask patients about patches, eye drops, ear drops, injectables, and topical medications: “Is there any medication that you put on your skin?”
- Ask about location – A mental tour of the home may yield discoveries: “Do you have any medications in your kitchen, on your nightstand, in your bathroom?”
- Ask about the latest new meds, stopped meds, and changed meds.
- Ask about OTCs for common conditions – “What do you take when you get a headache?” Do you take anything to fall asleep? Do you take any laxatives? What do you take for allergies? Do you take any pain medication?”
If you have questions about this article, please contact us. This information should not be considered legal advice applicable to a specific situation. Legal guidance for individual matters should be obtained from a retained attorney.
1 U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. National Action Plan for Adverse Drug Event Prevention. Washington, DC: 2014: 5.
Adapted from Medications at Transitions and Clinical Handoffs
(MATCH) Toolkit for Medication Reconciliation. 2012; AHRQ Publication No. 11(12)-0059: 43.