From hospital to home, studies confirm if it is going to go wrong, it will likely involve medications. Medication-related events account for up to two-thirds of post-discharge adverse events and are a major driver of hospital readmissions.
While meticulous medication reconciliation is essential to safe prescribing, obtaining a current and accurate medication list is a challenging and painstaking process.
- Make It Meaningful: When talking to patients and families, explain that obtaining an accurate medication list is critical to safe prescribing.
- It is Only Natural: While healthcare professionals are well aware of harmful interactions that occur when prescription medications interact with supplements, OTCs, and herbal preparations, patients may not volunteer this information. When interviewing, ask about prescription medications as well as over–thecounter medications, supplements, vitamins, herbal preparations, and nutraceuticals.
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Ask, and Then Ask Again: When memory fails, experts recommend rephrasing the question to trigger recall.
- 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 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 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, or in your refrigerator?”
- Digging Deeper – Uncovering Nonadherence: As any seasoned practitioner can attest, just because it is on the list, does not mean the patient is taking his or her medication or taking it as he or she should. It is important to not only ask if the patient is taking the medication, but how he or she is taking it. One way to start this conversation is by asking if there are any medications that they have questions about or ones that are not working for them.
- When Communicating with Patients, Keep It Simple! Low health literacy is one of the major factors contributing to medication nonadherence. It is important to understand that any patient’s ability to comprehend and retain information can be adversely impacted by stress, pain, medication side effects, or simply a lack of familiarity with content. Therefore, some educators believe the best strategy is to use simple, plain language whenever possible. Plain language is language that would likely be immediately comprehensible to the majority of patients (e.g., it’s “your blood pressure pill” versus “your antihypertensive medication”). Finally, when educating, use the “teach back” method to verify the patients’ understanding. The teach-back method involves asking your patients to repeat in their own words what they need to do when they leave your office.
Providing patients with a master list of their reconciled medications, instructing them to carry the list to every physician appointment, and to update it whenever medications are started, stopped, or changed can help improve the medication history conundrum. Annotating the list with lay language and explanations of medication purposes (e.g., warfarin = blood thinner) can help assist patients to recognize and recall their medications.
Foster, A.J., Murff, H.J., Peterson, J.F. et al. (2003). The incidence and severity of adverse events affecting patients after discharge from the hospital. Ann Intern Med, 2003 Feb 4; 138(3): 161-7.
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.
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