Take a guess - how many people in the United States take at least one prescription drug every 30 days?
If your first thought was "a lot," you're right. According to data from the Mayo Clinic, nearly 70% of Americans are on at least one prescription drug, and more than half take two or more. Those figures are remarkably high and don't include over-the-counter (OTC) medications.
With so many people taking so many medications, the process by which health care providers elucidate their patients medication-taking behavior is critical. Effective medication reconciliation produces an accurate list of all medications a patient is taking, including drug name, dosage, frequency and route. If just one medication is missed or a single data point overlooked or captured incorrectly, the ramifications may be dire. Errors such as omissions, duplications, dosing errors and drug interactions can lead to adverse drug events that can cause great harm or even potentially kill patients.
Improving Your Medication Reconciliation Process
Here are four ways to strengthen your medication reconciliation process and enhance patient safety in the process.
1. Capture all medications and their details
When assembling a list of a patient's current medications, you want to ask about any prescription and OTC medications. But that's not all. Make sure to also ask about vitamins; herbals; health supplements; nutraceuticals; respiratory therapy-related medications, such as inhalers; vaccines; and intravenous solutions.
When gathering dosing information on these medications, try to capture at least the following:
- medication name;
- frequency and
- most recent dose taken.
2. Help patient recollection
Patients who take a number of medications may struggle to recall all of them. By using "probing questions," you can help patients better remember the medications they are taking.
Examples of types of probing questions include the following:
- Open-ended questions such as, "What do you take for your high blood pressure?"
- Closed-ended questions such as, "Do you take medication for your back pain?"
- Questions about routes of administration other than oral such as, "Do you put any medications in your eyes?" Since most people think about taking medications through their mouth by default, it can be easy to forget their use of ointments, patches, eye and ear drops, and inhalers.
- Questions about specific conditions such as, "What do you take for your diabetes?"
- Questions about when they take medications, specifically asking about medications they may not take daily (e.g., weekly, monthly, as needed) as it can be easy to forget about medications with less frequent dosing regimens.
- Questions about recent changes to their medication regimen such as new or stopped drugs and altered frequency or dosing.
- General questions about OTC medications such as:
- "What do you take for general pain relief, like a headache?"
- "What do you take to treat a cold?"
- "How do you treat allergies?"
- "Do you take any medications to help you sleep?"
3. Factor in health literacy
According to a national survey, more than one-third of the adult U.S. population has basic or below basic health literacy levels. Patients with limited health literacy may struggle to adhere to a medication regimen. They may also struggle to share an accurate medication history with providers.
It is imperative for providers to take their patients' health literacy into account when working to assemble an accurate medications list. One of the more effective ways to overcome some of the barriers associated with inadequate health literacy is to focus on improving communication. The use of probing questions such as those identified earlier can help. Use simple language and speak slowly. Relieve some of the burden on patients recalling what medications they take by encouraging them to bring their medications to you, if possible. Just don't assume that what they bring necessarily represents all of their medications.
4. Focus on high-risk situations
There are many barriers to successful medication reconciliation, with some representing more significant challenges than others. Health literacy, as discussed, is one such barrier. Cognitive impairment has been identified as another, with experts recommending the use of a simple screening tests such as the Mini-Cog to identify impairment in older adults in a timely fashion.
A third barrier that receives frequent attention in research and journals is the transferring of cases to an external organization (i.e., outside of the system). One of the main reasons why external transfers present such a challenge is the dissemination of information and need for effective care coordination between the organizations. In all likelihood, these organizations are not sharing electronic patient data. In addition, external transfers require the review and reconciliation of three sources of patient medication information: 1) patient's list of home medications prior to visiting the initial organization; 2) medications administered by the initial organization during the patient's visit; and 3) medications ordered at the receiving organization.
If your organization transfers or receives patients from another organization, you must implement a process to address these reconciliation needs. Effective communication and handoffs between organizations, especially those not within the same system, is critical to ensuring all medications are accurately shared and documented.