ENHANCING MEDICATION SAFETY:

Transcription

1 ENHANCING MEDICATION SAFETY: Conversations with Patients and Caregivers Lisa Sever, BSc PHM, ACPR, CGP, RPh

2 What medications are you taking? Seems to be a relatively straight forward question.. Or is it??

3 Medications, Medications, Medications Vials Bottles Punch out packs in boxes Weekly Compliance packages Pill boxes / organizers Drops, sprays, creams, patches Needles Devices

4 Polypharmacy* is a big risk factor *typically defined as > 5 medications

5 Written Medication Instructions

6 Wholly complicated!

7 Accurate medication intake is essential for assessment

8 Interview the Patient

9 BPMH Structured Interview A series of questions to help make the Best Possible Medication History Systematic approach Prompts the patient from different sides to try to get the complete picture Just google BPMH guide to access the pdf version (or can buy pocket cards from ISMP Canada)

10 Top 10 Questions for Interviewing

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12 Look at the environmental and physical cues Dust on the lid Text on labels worn off Caps not replaced Expiry dates Medications disorganized

13 The mystery may lie in the old medications you find

14 Assume there is some non-adherence Everyone forgets to take their pills sometimes. How often does this happen with you? Which pills do you sometimes choose not to take? How often do you do this? If using a compliance package - when you miss a dose, what do you do with the extra pills?

15 Empty compliance packages - Beware the contents are lurking elsewhere

16 TALK ABOUT REASONS THEY DON T TAKE THE PILLS Most often the reason are really REAL

17 Reasons for Non-adherence Five Dimension 1. Social and Economic 2. Health Care System 3. Condition-related 4. Therapy-related 5. Patient-related both physical and psychological / behavioural American College of Preventative Medicine

18 What are your concerns with the medications?

19 Ask specific questions about how they use medications

20 And when and how they discard their medications

21 Discuss Medication Risks that are relevant Important to have conversations about risks of medications (potential side effects, additive toxicities) Falling Memory impairment Stroke Respiratory depression Important to talk about the risk of Non-adherence or inappropriate use

22 QUESTIONING STRATEGIES PATIENT INTERVIEW

23 Case Study Mr. GB Patient self-referred 85 y.o male No past medical history provided Presented a blister pack to home visiting pharmacist Said he has trouble remembering and takes too many pills

24 Case Study Mr. GB Initial interview Allergies or medications that caused side effects? Reviewed blister package contents Validated indications through dialogue Do you know why you are taking this? Outcome / Efficacy Is this medication working for you? Are these the only medications you take? - He replied yes Result: His bowels were working just fine so he was not taking the red stool softener Some understanding of the indications

25 Case Study Mr. GB Using a structured approach helps to get a clear picture Ask about different dosage forms Ask about indications that lead to OTC use: Heartburn, headache/pain, constipation, diarrhea, cough/cold, vitamins Ask about natural medicines Result: GB has a nitrospray that has been in his glove compartment for the past couple of years

26 Case Study Mr. GB Other good questions for prompting: Are any of your medications too expensive for you? Do you have to get blood work regularly for any of your medications? Where do you go? How do you get there? Results GB is using Apo-K 8 meq for potassium losses from his furosemide but indicated it is costing too much Goes the family MD to get his blood test weekly for his rat poison FOUND OUT HE WAS ON WARFARIN separate vial has to pay $10 each time for test. Asked him to get me his warfarin how much are you taking? Do you know why you are taking?

27 Case Study Mr. GB Questions about adherence and disposal If you forget to take some pills, what do you do with them? Do you ever forget to take warfarin? Result: Mr. GB went to grab the mixed vials full of the pills he didn t take Could see lots of stool softeners and furosemide Often forgot to take 2 nd dose of furosemide (was in the dinner slot of his pill pack) Forgets to take warfarin ~ 2 times a week

28 Case Study Mr. GB Environmental Scan / Clues What other medications do you have in that cupboard? I see that you have a glucometer on your shelf how often do you test your blood sugar? Result: Found some metolazone (another water pill) that he didn t like to take Tylenol #3 s that he uses sometimes Admitted he didn t know how to check his blood glucose and had no strips he was told he is borderline DM

29 Mr. GB s medication

30 Mr. GB s medications

31 Defining and setting the plan Help the patient or caregiver with the concerns they have identified first Provide any education required Discuss any medication risk situations that have been identified Get buy-in (permission) to address the issue Accept their wishes if they choose to live at risk Sometimes this is just the spark that is needed for the patient or caregiver to take ownership and start the conversation with their doctor

32 Let s help our patients be safe and successful at home with their medications

33 Medication Safety at Home Thank you