Engage patients in medication management

Engaging your patients, their parents or caregivers to be active participants in safe medication management is important. Instruct patients to carry a complete list of their medications at all times, including over-the-counter medications. Many organizations, large chain pharmacies and pharmaceutical companies offer medication forms or wallet cards for patients to carry with them. Pharmacies are also willing to provide printouts of prescription dispensing histories for patients and physicians.

However, be cautioned that this may not be a complete listing if patients use multiple pharmacies.

Other suggestions include a BYOB (bring your own bottle) process instructing patients to bring their medication with them at each office visit so that reconciliation can be achieved.

The role of physicians in the medication counseling process cannot be overstated. Feedback from insured physicians indicates that this process usually consists of limited information since pharmacies provide package inserts when the prescription is dispensed. Reliance only on the pharmacy to provide this information is an unsafe practice since pharmacy dispensing errors may occur.

The AHRQ’s study of ADEs in children in the ambulatory setting indicated that many of the events were attributable to errors in administering medications by the parents. In addition, parents did not consistently inform clinicians of ADEs when they occurred, leading the authors to conclude that communication between clinicians and parents regarding the issue of medication side effects must be improved.

At the time of the office visit, patients should be provided oral and written instructions on the use of their medications, and they, their parent or caregivers, should be asked to repeat back the information in their own words to demonstrate understanding. Studies have shown that the root cause of ambulatory ADEs is frequently due to the patient not knowing the proper way to take medications. One study indicated 42% of patients could not understand simple instructions on a prescription bottle.[1]  Patients with limited health literacy not only struggle with written communication, but also with oral communication.[2]

While it may seem unnecessary, prescribers need to stress to patients the importance of getting the prescription filled, taking the medication as ordered and the potential consequences of non-compliance. Remember that prescribing medication with potentially significant side effects requires the patient’s informed consent. This discussion should include the proposed drug’s benefits, risks and alternatives. Any follow-up care or required monitoring should be understood by the patient and the plan should be documented in the record.

Conclusion

Empowered patients well educated about their medications provide a “safety redundancy” within the process of medication ordering, dispensing and administering. Make it easy to do the safe thing by adopting a medication management process that includes reconciling medications on a quick-glance list and engaging your patients through effective communication and education. Many organizations have resources to make it easy for you and your staff to prevent adverse drug events.

Resources

ü  For more information, check out the “Medication Safety” chapter and “Communication Tool” in our Physician Office Practice Toolkit, which are available to insureds on our secure website at princetoninsurance.com (you must be logged in to view the toolkit).

ü  Madison Patient Safety Collaborative – patient wallet cards, patient medication safety brochure & tip sheet (madisonpatientsafety.org).

ü  CVS Pharmacy – Personal Medication Inventory (www.cvshealthresources.com/Imagebank/
Health_Diaries/PersonalMedInvent.pdf).

ü  Two videos to educate your staff on the importance of patients' health literacy (www.ama-assn.org/ama/pub/category/8035.html).

ü  American Academy of Family Physicians – links to a variety of different language health resources (aafp.org).

ü The Agency for Healthcare Research & Quality – “Your Medicine: Play It Safe,” to help consumers use prescription medicines safely. The 12-page brochure, available in English and Spanish, includes a detachable, pocket-sized medicine record form that can be personalized (ahrq.gov).

ü The American Academy of Family Practitioners - Guides in English & Spanish on how to manage medications (familydoctor.org).