THE IMPORTANCE OF MEDICATION RECONCILIATION
Michele N. Lossius, M.D., is our UF Health Shands chief quality officer, chief of pediatric hospital medicine for UF Health Shands Children’s Hospital and an associate professor of pediatrics in the UF College of Medicine. She is pictured here (center) with her grandmother and mother.
Medication reconciliation is a complex matter, and across the nation, many organizations face the same challenges we face at UF Health when it comes to improving this process for patient safety. While communication may seem like an obvious step when reconciling a patient’s medication list, it’s important to stay consistent in our communications with members of the health care team and patients throughout the continuum of care. I think all of us struggle with this — but as physicians, nurses and pharmacists, those of us working with patients and their medication regimens, we must be vigilant in communicating changes in medications, possible side effects and indications with our patients and their families.
As the medical proxy for my grandmother, I have experienced firsthand how challenging reconciling medications can be. Last year, during her discharge process, I was working with her physician to determine next steps with her medications. I asked many followup questions and challenged the process when it came to what medications she had to take, when she had to take them and how to get additional medications due to this new regimen. As a physician myself, I know the process, but had my grandma not had someone well-versed in health care to help, this would not have gone well. The onus should not be on patients and their caregivers, who are already overwhelmed by their medication regimen, to facilitate transition of care during these stressful times.
Clinician errors and patient confusion surrounding medications pose a patient safety risk. As health care providers, we need to know all about the medication we are prescribing. We need to be able to tell the patient what it’s for, what the most common side effects are and what they should do if they experience any of those side effects. To improve communications, we must take time to ask patients what questions they have and provide an avenue for questions following hospital discharge. It’s crucial to follow the teach-back technique — where patients and their caregivers are asked to explain in their own words the purpose of the medication and any possible side effects. It is important for patient outcomes that we educate patients on the medications they are taking and provide written materials to ensure compliance. If we don’t know how to answer a specific question, we should reach out to available resources. Pharmacists working on the hospital floors or within the pharmacy department have great knowledge about medications. Let’s work together.
As clinicians, we find that if a patient doesn’t understand why they are taking a specific medication, they will not take it. If they experience any side effects and they don’t seek care or stop the medication, they can put their safety at risk. If we take the time to communicate and better explain their medications, we will create better patient compliance and outcomes.
In the example with my grandmother, had I not asked questions about her medications, she would have been readmitted, which would have been a preventable, worst-case scenario. However, others may not feel comfortable or know to do so. Patient centered medication administration is equal parts provision of a medication and our most attentive communication about its purpose.
As health care providers, it is up to us to provide the best possible patient experience, and medication reconciliation is one step we can all take to ensure that happens for our patients.