Issue link: https://viewer.e-digitaledition.com/i/163833
According to a report by the Institute of Medicine, four out of five adults in the United States will take a weekly medication cocktail featuring either prescription medications or over-the-counter drugs, such as herbal or vitamin supplements, leading to 1.5 million preventable adverse drug events every year. + Flag the record w ith patientspecific reminders. Seeing patients with similar names or conditions day in and day out may cause certain details to blur together. Mark each record with information specific to that patient, such as date of birth and full name, to keep the details clea r before you head into the exam room or load up their file at the bedside. + Spotlight chronic conditions. For patients managing ongoing health conditions with medication, make a note to continually check in about how things are going in their records, so dosages can be adjusted as needed. + Spell it out. Using an abbreviation might save time, but it could also cause unnecessary confusion. Be clear when noting drugs and dosages on paper or electronically. Running out of time to explain a certain point, or feel a patient needs extra explanation? Leaning on medical staff or other trusted medical providers can help ensure each patient's needs are met. "Working with nurses, pharmacists and other hea lth professiona ls is very useful," says Dr. Steinman. "For example, a nurse [...] working with the practice can call patients every [few] weeks after they have started a drug and ask about the effectiveness of that dr ug a nd about potentia l adverse effects." When EHR Doesn't Tell the Whole Story Under t he Hea lt h Information Technology for Economic and Clinical Health Act, all medical practices will need to prove meaningful use of EHR by the end of 2014. While EHRs are making strides toward pinpointing potential drug interactions, taking time to ask the same questions every visit could make sure the patient's prescription list is as up to date as possible. Don't assume — always ask. "Electronic hea lth records ca n improve documentation of medication prescriptions and, depending on the system, provide decision support," says Dr. Steinman. "However, tidy medical records can instill a false sense of confidence. Just because a medication is documented in the record doesn't mean patients are taking it." When reviewing medications with patients, ask: + How long have they been taking it? + Has the dosage changed? If so, why? + Have they stopped taking a medication? If so, why? + Have they started taking over-thecounter medications, such as allergy medication or vitamin supplements? Why are they taking these medications? How often and how many doses are taken? Is it regularly used medication or used on an as-needed basis? In some cases, seeing is believing — and MIND THESE MEDS SOME MEDICATIONS MIGHT cause minor side effects, such as stomach upset or dizziness, which can be easily managed. Other medications can have more life-threatening effects. Medications considered highalert items by the Institute for Safe Medicine Practices include many injectable drugs such as heparin, magnesium sulfate, nitroprusside sodium, potassium chloride and phosphates, as well as oral blood thinners such as warfarin. For patients with cognitive issues or memory disorders such as Alzheimer's disease or dementia, no symptom should be overlooked. "Simplifying the medication list and removing medication which might worsen cognition is important," says Michael Steinman, MD, Associate Professor at University of California, San Francisco and the San Francisco VA Medical Center. "I try to keep in mind the adage 'any symptom in an older adult is an adverse drug effect until proven otherwise.'" understanding. Physically bringing in medications could also pinpoint problems, Dr. Steinman says. "An intermittent brown bag review in which the patient is asked to bring in all their pill bottles can provide great insights into what the patient is actua lly ta k ing a nd how their medications are helping — or harming them," says Dr. Steinman. "Routinely check in about the effectiveness and potential harms." For more tips about reducing medication errors, visit www.aafp.org. I MDNEWS.COM I MD NEWS Greater Boston | 17