The onus is generally on patients
to make sure they're taking their meds correctly, but
when they have trouble, it falls on you to set them
right again. If you could help patients keep their scripts
up to date and in order, you could save them —
and yourself — countless hours of frustration.
It can be a chore for some patients
to keep all their medications straight. Every additional
prescription a patient gets compounds the need for monitoring,
the odds of non-compliance and makes adverse drug events
(ADEs) more likely.
In one study, Dr Alan Forster,
an Ottawa internist whose research concerns patient
safety after hospital discharge, found 11% of patients
suffered ADEs. Around 2% of those were life-threatening.
The good news is that more than a quarter of ADEs are
preventable, says Dr Forster — prov-id-ing you
teach patients how to get organized.
Here's how:
START
A DIARY
Patients aren't always as interested or involved in
their own medication as they probably could be, says
Dr Forster. To help patients help themselves, he advocates
the use of medication diaries, especially for patients
on multiple meds.
A good diary, he explains, should
contain information on every drug the patient is using.
This includes a drug's name, prescribed dose, its indication,
whether it was stopped, and why. "Patients should also
keep track of side effects they have while on a drug,
and whether the problem it was prescribed for persists,"
he says. The drug diary can be a repository of up-to-date
information on a patient's treatment history, and it
can be helpful to any doctor examining your patients.
A sort of poor doc's EMR, its flaw is that it's only
useful if you can get patients to stick with it and
bring it to every appointment.
EMPHASIZE
HAZARDS
Another way that doctors can get their patients focused
on their medications is by advising special caution
whenever prescribing drug classes which carry particularly
high risks. "When patients are on things like anticoagulants,
seizure medications, sedatives, narcotics, diabetes
drugs, there should be extra attention paid to these
drugs," says Dr Forster. Make sure your patients understand
the risks and side effects. The idea is simple, but
Dr Forster's research suggests that clearly explaining
side effects to patients cuts ADE rates, by as much
as 60%.
STAY
IN TOUCH
High-risk patients should have a phone number where
they can reach you in emergencies. Write it in your
patients' medication diary, and you'll reduce plenty
of unnecessary office visits.
ELIMINATE
BARRIERS
Physical limitations can make organizing medication
tasks hard for seniors and the disabled. When writing
prescriptions, add a note asking the pharmacist to use
a larger, easy-open drug bottle for arthritic or weak
patients. Suggest a large-text drug label, if possible,
for the visually-impaired. When explaining drug directions
to the hard of hearing, ask patients to repeat what
you've said to make sure they're getting it and write
things out for them to help them remember.
USE
MEMORY AIDS
Go ahead and ask elderly patients if forgetting, or
forgetting how, to take their medications is a problem.
Recommend the use of dosettes or pill boxes. Dr Forster
cautions that if a pharmacist makes a mistake when stocking
the dosette, patients are unlikely to catch it themselves.
Nevertheless, memory aids generally do greater good
than harm in more extreme cases of forgetfulness.
A
NATURAL DISCUSSION
Certain unregulated health-related products like herbal
supplements can interact with prescription drugs or
affect the way they're metabolized. Make sure patients
realize this, and always ask if they're using these
products. These products should be entered in the medication
diary. Ditto for OTCs and vitamins.
DON'T
TRUST "NKDA"
Asking patients about allergies to medications isn't
an infallible way of ensuring their safety — what
if they forget? Dr Forster says drug allergies might
be overlooked in patients you've had for a long time.
In these cases, medication allergies could've been recorded
long ago, but were never relevant to the patient's treatment...
until a problem arises requiring an allergy-inducing
drug. Don't forget to go way back in those records whenever
prescribing. Put it in their diary.
TIDY
UP, DOC
That doctors' handwriting thing might be a little overblown,
but it's still an important consideration. Don't let
patients leave with an illegible prescription. Dr Forster
suggests avoiding the use of abbreviations: for instance,
"q.d." might be mistaken for "qid" by a pharmacist.
Just write "once a day," instead. See http://www.ismp.org/Tools/errorproneabbreviations.pdf
for a list of potentially confusing abbreviations.
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