When we think of medication management for our patients, I'm sure many of us think: "Oh that's not my responsibility-that's something the nurse does." Not anymore! This is something we all must have a hand in to keep our patients safe at home. It is now the responsibility of all professional disciplines to ask about medication changes on every visit we make.
This is a new policy that my agency has instituted. Don't be surprised if you see it at your agency soon. This is being done to help keep track of what medications the patients are on, what changes are occurring during the episode of treatment, and to make sure patients are not mismanaging their medication. We see this all too often, and it can affect the patient's progress and his safety/health.
Each time one of the "team" visits a patient, he or she is to ask if there have been any medication changes. If there has been a change, we are to find out what the change is. If it is a new prescription, we add it to the medication list in the home. If it is a change in dosage of an existing -prescription, we notify the RN on the case, who will update the medication list in the patient's home. If there is no nurse on the case, then we communicate the change to our triage department, which confirms it with the doctor and writes a verbal order.
For example, a patient receives a call to change his coumadin from 2 mg to 4 mg. The medication profile should reflect that the 2 mg coumadin has been stopped, with the new order for 4 mg coumadin. This is to avoid the mistake that the patient may end up taking 6 mg of coumadin! Then we call triage, which confirms the dosage change with the doctor and writes the verbal order to confirm it.
If this is a therapy-only case, then the therapist writes up a medication profile and the patient-friendly medication list that gets left with the patient. The medication profile gets sent to the doctor, with a cover letter instructing him to call the triage department if there are any changes or corrections. The therapist must also screen to see if there is a nurse needed on the case due to the patient being on new or changed medication, side effects or that the patient and/or caregiver do not understand medication use.
If therapy is the last service in, then we see if there has been any change in medications. If so, then we follow what has been previously described. If no changes have occurred, we write a patient-friendly medication list and review it prior to discharge. Any questions that are outside the scope of our practice get directed to the triage department.
After posting a question on AOTA's Home and Community Health SIS listserv about medication management, I received a number of replies. Karen Vance stated: "The comprehensive assessment must include a review of all medications the patient is currently using in order to identify: any potential adverse effects and drug reactions, significant side effects, drug interactions, duplicate drug therapy, and noncompliance with drug therapy. The standard is not expecting us to do medication teaching, but as a critical part of a patient's occupational performance, we absolutely want to know how a patient integrates medication regime into his daily routine, and whether or not it's effective."
Carol Seibert made the point that, "Medication administration is an important IADL for home health patients-as important as preparing meals." She also said: "The medication review should include a review of all medications currently in use (including herbals and homeopathics), evaluating for ineffective drug therapy, significant side effects and interactions, duplicate drug therapy and noncompliance with the medication regimen.
"We can observe or hear about side effects, or taking more or less than what is prescribed, or getting duplicate prescriptions from multiple pharmacies, or taking someone else's meds, or taking over-the-counter or other medications that the physician is not aware of. We can recognize that a patient is experiencing breakthrough pain or other symptoms which are not being controlled by the current medication or dosage (ineffective drug therapy). We can ask patients to tell us about each medication as we record it, which tells us about their knowledge of the med and whether they are taking it appropriately.
"When the medication list is reviewed by a nurse in the agency, our findings in the home, combined with the nurse's knowledge of the specific drug indications and actions, is what produces an effective medication review. We've all seen situations like this?and realized that what gets listed on the medication list does not reflect how the person is taking the meds."
As we try to keep our patients out of the hospital, medication review is the least we can do to help this cause. It is yet another way to help our agencies and have them realize how valuable occupational therapy is to keep our patients at home.
Phyllis L. Ehrlich, MS, OTR/L, CHES, has been an OT for more than 29 years and has been working in home health for more than 19 years. She currently works for Holy Redeemer HomeCare. She has specialized training in NDT and is a certified health education specialist. She has co-edited and is a contributing author to Home Health Practice: A Guide for the Occupational Therapist. Readers may contact her by e-mail at firstname.lastname@example.org.