Knowing all of the prescribed medications your patients are taking is vital to care and treatment outcomes.

Posted in Risk Management on Tuesday, December 20, 2016

During a recent assessment, we inquired as to why medication lists for numerous patients were not complete. 

The practice manager advised that many times patients do not know the medications they are taking. They went on to state that even when patients were asked to bring their medications to appointments, they often failed to do so. As a result, the practice manager felt there was nothing more that could be done. 

So, the practice continued care without knowing patient’s current medications for sure. Yikes.

Unfortunately this is not a lone incident that we have come across when reviewing records.

The importance of complete medication documentation

Knowing all of the prescribed medications your patients are taking – as well as any over-the-counter drugs, vitamins, nutritional supplements and herbal medications they may be using – is vital to care and treatment outcomes. 

Additionally, research has found patient (or caregiver) self-medication error rates range between 19% and 59% – with the elderly and pediatric patients leading the findings. For example, most of us have heard of someone ingesting a suppository. 

Medication administration errors can include actions such as forgetting to take the prescription, taking the wrong dosages, combining over-the-counter drugs with prescription drugs and chewing vs swallowing or inserting – to name a few.

How a brown bag medication review can help   

A brown bag review can help reduce medication administration errors and build rapport with your patients. As part of the Agency for Healthcare Research and Quality’s (AHRQ) Health Literacy Universal Precautions Toolkit, the brown bag review does this through a thorough review of patient medications, supplements, etc.

The AHRQ’s brown bag overview provides examples of patient experiences using the tool, action steps for getting reviews off on the right foot and tips for preparing for and performing reviews.

In addition to reviewing patient medications, brown bag reviews also include an opportunity for conversation. This conversation can help you and the patient understand why they are taking a medication, how they are taking it and how much they are taking. 

Brown bag reviews can also reveal where patients are purchasing medications, locally or from online pharmacies. If they are purchasing through online pharmacies, you can take this time to direct them to safe sites.

Creating a successful medication review process

For brown bag reviews to be successful, patient buy in is required. Patients need to understand that you are working together with them for their benefit. 

Open ended questions, such as “tell me how often you take this medication”, can help with the conversation and with patient understanding. You can also use the teach-back method to help make sure that patients understand your instructions and comments.

To start brown bag reviews at your practice, it may take some diligence in the form of reminding patients that you want to provide this to them and how important it is for their healthcare. One practice helped with this by having special bags made for patients to use. 

When you perform a brown bag review, be sure to document the patient’s records of your efforts and confirm that medication lists are complete and up-to-date. You should also provide the patient with information on what medications they are currently taking and how they should be taking them. 

Lastly, brown bag reviews should be performed annually and after any significant healthcare events such as a hospitalization.