Your patient walks in with a bag full of pill bottles, or rummages through her purse, pulling out old prescription bottles and little baggies of pills. Is this any way to gather a medication history?
Medication reconciliation is a key part of every patient history. It is a hugely time-consuming task and every health care professional knows the results are highly questionable—because patients often don’t know the names of pills they are taking or the dosages, and they can’t remember whether they actually took them yesterday.
Of course, there is no specific protocol for collecting this information. Most hospital and physician waiting rooms provide forms that ask for a list of current medications before the visit, and the nurse or PA then methodically reviews each item of the list. Are you still taking this medication? Oh, no, I stopped that a while ago. When? I can’t remember.
The medication reconciliation is important for a number of reasons, including:
- Assessing efficacy
- Reviewing potential side effects
- Evaluating patient adherence to and correct use of therapy
- Making sure therapy is the correct one
- Determining modifications
- Considering drug interactions when adding new therapies
Aside from the challenges of patient and family recall of drug history, medication reconciliations from different offices are rarely, if ever, compared. If a patient visits the ED for an infection that heals before the next office visit, he may forget to mention the two different courses of antibiotics he tried. Obviously, at any given time, a medication history is less than complete, and may sometimes do more harm than good.
How to Better Use Medication Information
There are some good ways to conduct medication reconciliations that allow you to mine important information while continuing your medical evaluation.
- Take the Big Approach
Try to get a picture of the totality of medications the patient is taking and why. Talk with them about their concerns regarding each.
- Less is More
When someone is sick or injured, the number of medications — including vitamins, supplements, and OTC meds like cough drops or NSAIDS — can mount up. And so do the reactions. Skin reactions, changes in mood or sleep patterns, weight gain or loss, stomach upset, and headaches are all common reactions to one or more medications. Look for ways to streamline what the patient is taking and reduce the number of overall meds, which will reduce medication errors as well.
- Understand the Patient’s Attitude Toward Medications
Some patients look for a pill to make everything better, while others avoid anything they consider unnatural. Discussing how patients feel about their medications will help you understand a great deal about other aspects of their medical needs, such as using alternative therapies, and fears that may interfere with necessary tests or procedures.
- Redundancy is Okay
Asking the patient or family the same question may not get the same answer — and that can turn up something new.
- Use Technology
Rather than sorting through the bag of pills, ask your patients to take a picture of their pharmacy prescribing information for every med — or bring the PPIs with them. Use the patient portal to list all medications so you can discuss them next time — and others in your practice will have access to the same information.
Last updated on 9/22/19.