Undesirable Outcomes
Any unexpected or dangerous reaction to a drug
What is an adverse drug reaction?
Lack of training
Inadequate drug knowledge and experience
What are two of the reasons we make errors?
"Any changes to your med list? No? OK, great."
Come on, you know that's not good enough.
To obtain complete information about the patient's medication regimen
What is the goal of medication reconciliation?
Asking a question such as "What medications do you take at home?"
What is an open-ended question?
A situation in which a substance (usually another drug) affects the activity of a drug when both are administered together
What is a drug-drug interaction?
"Who cares if I go through all these meds. No one will notice and it doesn't really matter."
What is an inadequate perception of risk?
"Any changes to your med list"
"No?"
"Do you still take simvastatin?"
"No."
"So that's a change to your med list..."
What is a common communication problem?
Name of each medication
Formulation
Dosage, Route, Frequency
Non-prescription medications
What is information required for the medication list?
Medications taken only sometimes
What are PRN or "as needed" medications?
The unexpected failure of a drug to produce the intended effect
What is lack of efficacy?
Distractions and interruptions
What are factors contributing to the difficulty in obtaining a complete medication list?
"I only take the levothyroxine once in a while...when my gout flares up...that's what it's for right?"
What is inadequate patient literacy?
Bottles or medication lists brought in by the patient, existing list in Athena, discharge med list, careful patient/caregiver interview, a phone call to the pharmacy
What are sources of information for medication reconciliation?
What symptoms prompt you to take this medicine?
What is a probing question?
The degree to which the person's behavior regarding medications corresponds with the agreed recommendations from a health care provider
What is patient medication adherence?
Complexity of clinical case, including multiple health conditions, polypharmacy and high-risk medications
What is something that contributes to frequency of medication errors?
Monday morning phone call:
"Hi. Can you please refill my medicine for me?
...I'm not sure what it is called. It's white...
...I'm not sure who prescribed it before...
...I'm not sure what pharmacy I use, I think it's in Minneapolis..."
What is ...a common mess?
Try to use at least two sources of information and explore discrepancies between the different sources
What is best practice?
Limited-course medications (such as antibiotics) for which the course has been completed.
What is a medication that the MA/PCT/RN can remove from the medication list
The action or fact of dying or being killed; the end of the life of a person or organism
What is death? (this is an undesirable outcome)
We are in a hurry and these complicated conversations are time consuming
What is one reason we fail to do a comprehensive medication reconciliation?
"I stopped taking that daily aspirin because it was making me see rainbow halos around all the pretty girls and I was hearing the aliens sing all the time, not just when I was listening for them..."
What is a perceived drug side effect? (that is likely unrelated to the drug)
"Do you still take Cialis?"
What is a question that we have probably skipped?
The practitioner is responsible for adding and deleting medications during outpatient visits.
The MA/PCT/RN gather the information for medication reconciliation, and the practitioner performs it.
What are VV and JC standards?