Do you find it difficult to keep a current medication list? Is your patient seeing various specialists, cognitively impaired, or taking numerous medications and only know the patient "takes one white pill in the morning and two red ones at night"?
Medication errors and adverse reactions occur in all healthcare settings, including the physician's office practice. Errors can arise from specific contributing factors such as wrong dosage, wrong medication, drug interactions, or use of multiple opioids. Practices that have implemented an electronic health record (EHR) system have mitigated some of the inherent risks such as illegible handwriting, but EHRs have also created unique risks related to e-prescribing, including use of drop-down menus, keystroke errors, and copy and paste. To mitigate these risks, rigorous medication management policies should be adopted in the office setting.
When developing an office medication reconciliation policy, a good place to start is when patients call the office for their first visit. Instruct staff to tell the patient to bring to the appointment all the medicines they take, oral or injectable, ordered by a physician, and all over- the-counter medications such as vitamins or herbal supplements. With established patients, some practices provide a written reminder or insulated tote as a reminder for patients to bring their medications to each visit.
Medication reconciliation is a three-step process and is the responsibility of everyone from physician/staff, patient, family members, and caregivers.
Verification – What is the patient taking and why? This is the most challenging step.
Clarification – Ensure the medication and dose are correct and taken appropriately.
Reconciliation – Document any change.
It is important to document from whom the information came so that any discrepancy may be tracked and revisited if clarification is necessary.
Reconciliation is done at each step of the patient’s interaction with healthcare providers, or when treatment has changed. This facilitates an understanding by the patient about his or her treatment plan, what each medication is for, and minimizes contraindicated medications. Patients should also understand when and why it is important to follow up with the physician about their medications.
The best way to maintain accurate medication reconciliation is to utilize a form that includes: medication name, dosage, frequency, route, and any special instructions. This form should be given to the patient and should be brought to every visit. The form should be simple and accommodate room for medication changes.
Remind patients that two important benefits of an accurate and timely medication reconciliation process are patient safety and minimizing risk by avoiding adverse drug events (ADE). ADEs often lead to hospitalization and possibly death.
Finally, a word about e-prescribing. Remember to use caution with the e-prescribe drop-down menu. Double-check each entry to be sure the correct medication is selected with the initial prescription and each subsequent refill.
Dona Constantine is a senior risk management and patient safety specialist for CAP. Questions or comments related to this article should be directed to dconstantine@CAPphysicians.com.