THUNDER BAY – Healthbeat – One of the most important steps in treating a patient at the Thunder Bay Regional Health Sciences Centre is finding out exactly what medications that patient is already taking. This “medication reconciliation” as it is called sounds easy enough. However, it is much more complicated – and errors more common – than you might imagine.
For example, a study at a Canadian hospital in 2005 found that over half of the patients admitted had at least one medication discrepancy. Of these over a third had the potential to cause anything from discomfort to serious medical issues in the patient. The most common problem was that patients weren’t taking the medications prescribed by their doctors once they were admitted to the hospital.
These errors and omissions can result in adverse drug reactions and other potentially dangerous medical complications. Hospitals across Canada and around the world including the Health Sciences Centre are rethinking how they do medical reconciliations to reduce these errors.
“There have been a lot different studies that have reported on the value of medication reconciliation,” said Jeff Chan, Pharmacy Manager at the Health Sciences Centre. “Canada is really seen as a leader in this area.”
Since there isn’t a central database that records all of a patient’s medications, the Health Sciences Centre staff must rely on patients, family members, and other sources to piece together all the prescribed medications. Some can be forgotten or missed. Today that is even more likely given the number of medications a patient might be on.
“Twenty years ago, it was very unusual for a patient to have more than 10 medications,” Chan said. “Now the norm is to see someone coming in with 15 medications or more. Medication regimens are incredibly complex.”
Another issue is that everyone’s idea of what is a “drug” is different. For example, patients might inadvertently fail to report Aspirin and Tylenol use or herbal medicines like St. John’s Wort simply because they don’t consider them to be “medications” like prescription drugs. Others might be uncomfortable talking honestly about their drug and alcohol use or even certain nutritional supplement use with staff.
And that increases the risk for adverse drug reactions and other medication complications.
Safer Healthcare Now!, a Canadian Patient Safety Institute program, has created a list of guidelines for acute care facilities like the Health Sciences Centre to help reduce the number of medication complications. The guidelines were developed with the help of the Institute for Safe Medication Practices based on research in Canada and around the world.
“The key to this is creating a Best Possible Medication History or BPMH,” Chan said. “If we get it done correctly upon admission, there will be fewer errors and we won’t have to continually ask the patient about their medication history.”
This process involves asking pointed questions about the patient’s health and lifestyle rather than relying exclusively on self-reporting. For example, instead of asking about use of over-the-counter drugs (to which a patient might say “none”), the staff member doing the medication history will ask about headaches, and what they might use to get rid of it.
Pharmacists are trained in this interview process as part of their education, and will be creating these histories in many areas of the Health Sciences Centre. However, some nurses like those in the surgical unit have been trained to do these interviews themselves.
The best way patients can reduce their own risk of adverse drug reactions or other complications is to be honest will all their medication use.
“The safest thing to do is identify everything,” Chan said.