On the record
How a simple list of medications is making a difference for patients and providers
By Molly Larmie
When new patients arrive at the UF Center for Movement Disorders and Neurorestoration, they receive a four-page questionnaire with small boxes for check marks. It doesn’t ask for personal information, family history or insurance. It asks patients to list their medications.
The questionnaire includes medications patients might take for movement disorders as well as blank space to record others. If patients are still taking a medication, they fill out how many doses per day, how many tablets per dose and the strength. If they’ve stopped, there’s a place to say why.
During the appointment, a nurse or physician goes over the list with the patient to make sure nothing is left out or stated incorrectly, said Danielle McGee, M.B.A, M.H.A, M.P.H, the center’s assistant director.
Returning patients go through the list the clinic has on file with a nurse or physician, making sure nothing has changed. By verifying their medications, patients play a major role in their own care.
News about this practice of checking and doublechecking patients’ medications traveled to Anzeela Schentrup, Pharm.D, Ph.D, director of clinical quality for UF Physicians and her team. They decided to make “medication reconciliation” the first phase of a new initiative to engage patients.
If patients are asked to verify their medications in the waiting room before their appointment, Schentrup said, they can use the time to develop questions for their providers or to catch mistakes. This practice already has been adopted by several other UF Physicians offices.
“I hope checking medications becomes as routine as checking insurance,” Schentrup said.
Shands at UF is also paying increased attention to patients’ medications, thanks to a research project by pharmacy resident Kathryn Hernando, Pharm.D. Concerned that many patients may not know what medications they’re on, Hernando piloted a program that would give patients the option to receive a daily list of their medications.
Hernando focused on the Shands adult medical-surgical units, randomly selecting from newly admitted patients. During her research, she found that patients who received a daily list were able to identify errors and inconsistencies in their medications. Some were incorrectly listed as allergic to certain medications. This is an important error: If providers think a patient is allergic to a first-line medication, they may have to prescribe something less effective.
At the end of the study, patients received a satisfaction survey, which asked if they wanted the option to receive a daily list. One hundred percent said yes.
Amy Rosenberg, Pharm.D., a pharmacy specialist in medication safety who served as research adviser for Hernando’s project, said Shands at UF is working to expand the program.
Because the practice grew out of individual clinics, there is no official system for verifying medications, yet. Some providers give patients a printout similar to an after-visit summary, which lists allergies and current medications.
Nurses decide when to print the paperwork and which patients should fill it out, Schentrup said. It doesn’t make sense, for example, to give a printout to a patient who relies on a parent or caregiver to manage his or her medications.
Despite the different approaches, the goal is the same: Patients should have a correct record of their medications each time they come into the hospital or a physician’s office. And the best way to achieve this goal is to get the patients involved, Schentrup said.
“It’s more effective if they are driving the change.”