Communicate before you medicate

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— Do you know your medications? If you are admitted to a hospital for care, you will be asked to provide a list of every prescription drug and over-the-counter medicine or supplement you are currently taking.

This growing emphasis on communicating about medications is happening not just at Yampa Valley Medical Center, but at hospitals nationwide. It is in response to patient safety goals set by The Joint Commission, a national accrediting agency.

One patient safety goal is to "accurately and completely reconcile medications across the continuum of care." To accomplish this, patients need to know all the medications they are taking so they can communicate this information to health care providers involved in their care.

At YVMC, our mission statement declares that we will "provide excellent healthcare to our communities through safe, personalized and quality services." How do we do this? One way is to continually look at how we reconcile a patient's medication record.

Let's start with an example: A patient is admitted to a hospital. The nurse provides an initial assessment, asking about medications that the patient currently takes. This information is documented on a list.

The nurse, or perhaps the hospital pharmacist, reviews the list and compares it to the physician's admission medication orders. Any differences are brought to the attention of the physician, and the medication orders are changed, if necessary. As the patient is discharged from the hospital, a copy of the patient's list of discharge medications is sent to the patient's primary care clinic or long-term care facility.

In reality, the above scenario doesn't always happen this way. Instead, upon admission, the patient tells the nurse that he/she takes "a little blue pill" for nerves, "a little yellow pill" for back pain and "a large white water pill." Who is going to figure out what these medications are?

"Upon admission, a patient can usually tell us what the medication they are taking is prescribed for but they are often unable to tell us the name of the drug and the strength or dose amount," explains Wes Hunter, pharmacy director at YVMC.

"It is not always possible to contact the prescriber or pharmacy providing the medications because a single patient often sees several prescribers and has prescriptions filled by several pharmacies. Additionally, our hospital is in a resort area and receives many patients from out of the area.

"We are encouraging our patients to keep a Home Medication Card in their wallet or purse that lists their known allergies, name(s) of medication(s) along with dose amount(s), including vitamin or herbal product information," Hunter said. "It's the first step in helping your physician and hospital care team to minimize the likelihood of medication errors, duplications and possible drug interactions."

This process has been shown to be a powerful strategy to reduce medication errors. Medication reconciliation has been implemented at YVMC through the pharmacy department with the assistance of fourth-year pharmacy students from the University of Colorado's Health Sciences Center School of Pharmacy.

The students spent their time learning about the Joint Commission's national patient safety goals of medication reconciliation, implementing a program that would meet those goals, and performing medication reconciliation for all inpatients at YVMC.

Future students will continue to reconcile medications and refine the evolving program. The students are here 48 weeks of the year; staff pharmacists perform reconciliation during the remaining four weeks.

YVMC has developed a Home Medication Card that can fit in a wallet. These cards are available at the hospital and will soon be distributed to physician offices and local pharmacies. We encourage all patients to be proactive and keep this valuable medication record up-to-date.

Lisa Bankard coordinates Yampa Valley Medical Center's Wellness and Community Education programs.

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