Recommendations for Medication Reconciliation (Part II)
Medication Availability
- In order to avoid unnecessary disruptions/changes in medication therapy regimes, items such as benefit coverage and affordability should be discussed with the patient and family and they should be engaged in shared decision-making around medication therapy.
Patient Agreement and Understanding
- When transitioning out of the hospital, the patient should be engaged in their plan for medications and agreement to follow that plan should be assured.
- Changes in the medication regime from pre-hospital medications should be made clear to the patient and family, including guidance on OTC medications and use of substances such as alcohol.
- Ask the patient and the family what medications are in the home and discuss the plan for their use or disposal.
- Teach Back is an effective strategy that should be used to elicit the level of understanding needed by the patient and family to take medications safely and as prescribed. (Project BOOST)
Recommendations for Patients with Mental Illnesses:
Quantity of Medications
- Condition-specific consideration should be given when ordering medication supply. For example, if the patient has had suicidal issues or major depression in the past, quantities of potentially lethal medications should be limited.
Communication of Medication Plans
- Acknowledging the complexities associated with medication therapy for mental illnesses such as required medication titration, it is imperative that the communication regarding intended plans for medications be clear to all providers caring for the patient as well as the patient and family.
Screen For Other Co-occurring Disorders
- Screen at-risk psychiatric and medical patients with such issues as trauma, stroke, myocardial infarction, cancer and diabetes, for possible substance use disorder. When warranted, use motivational interviewing methods.
Special Population Considerations
Special considerations should be given for patients who are:
- Incapacitated with respect to medical decision-making or have been deemed legally incompetent
- Confused or experiencing cognitive deficits
- On involuntary commitment
- In the midst of acute psychotic episodes
- Newly diagnosed
- Live alone without support
- Experiencing cognitive deficits
For these patients, consider strategies to enhance adherence such as:
- Direct observation of medication use
- Depot medications - a special formulation of the medication that is given by injection and gradually released into the body over a period of time
- Involvement of a case/care manager
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