One of the major pushes of the Joint Commission lately has been "medication reconciliation." It is a process where every time a patient is seen at a facility their medication list is obtained and theoretically checked by the staff and physician.
The problem is the physician involved is often a specialist. It may be a gastroenterologist performing a colonoscopy. The patient may be on 10 medications and there is no way for that physician to really tell if the list is completely correct. The patient has to be relied on to give an accurate list.
This is just one example of a flaw in a system created by the patients themselves. There are some things the system should do. First, generic names should be used at all times. Having two names for medications only creates confusion among patients. Sometimes it creates confusion for doctors. If I see a generic name I often know immediately what kind of medication I am dealing with.
Second, a single medication should be mandated to have a similar appearance. Having patients pick up medications that look different then previous because it is a different generic only causes confusion.
Third, all physicians should encourage patients to take more responsibility for knowing the drugs they take. Most patients ask about side effects but they almost never ask what the medication actually does.
Here are my recommendations for what patients should do:
Keep A List of All Medications Being Taken
Patients sometimes will say their medication list is in their record. This is a particular problem with VA patients who seem to think the Electronic Medical Record is an excuse to not keep a list of their medications.
The list is best placed on an index card and put in the wallet. It should include name of the medication with dose and frequency it is being taken. Optionally, it might include the diagnosis for which the medication is being taken.
In 2012, a patient could also consider keeping the list on their phone.
If a patient does not have a list there is reason to think they really do not know what they are taking. That leads to the possibility that they are not taking their medications properly. Studies show even when patients do know they may miss doses 30% of the time.
This list can be handed over to a nurse or physician or other provider immediately and is far more effective than any "medication reconciliation" process. It makes a patient more involved in their care as well.
Never put medications in a different medication bottle
This may seem obvious but many patients do in fact move medications into different bottles. This is a dangerous practice because now a medication is in a mislabelled bottle.
People seem to think they will be able to remember but more than once I have seen this practice lead to trouble. This can be for other people who may inappropriately steal the medication as well.
Know what medications look like
Most doctors do not know what the "little white one" is. That is not an acceptable way to remember a medication. Truth be told if a patient describes the appearance of most gastrointestinal drugs I have some idea what they are talking about. But that becomes far more difficult when generics get involved.
If a patient is taking Esomeprazole for GERD they should know it is a purple capsule. It is just another way to be confident that the right medications are being used.
Patients should use reminder mechanisms
Some patient use containers by day to make sure they take their medications correctly. Some medications come in blister packs. Some patients may use alarms to remind them to take medications.
The better compliance a patient has with medications the more they understand what is being done with the medications. It forces necessary understanding.
Manging pharmacology is just one example of how the system cannot work without the cooperation of the patient. Organizations can mandate all kinds of processes but at the end of the day the process will never succeed if garbage is put into it.
Careful now, do not tell the bureaucrats who think they are saving the world.
