When you visit your health care provider these days, one of the first things you may be asked to do is “reconcile your medications.” That fancy term always makes me think that we need an attorney or a judge to mediate the negotiation that is to take place. Fortunately, legal experts are not necessary for this process! Medication reconciliation is defined as a formal process of identifying every medication a patient is taking (including prescriptions and over-the-counter drugs, herbal supplements and vitamins) and using that list to make sure you, the patient, are provided with the correct medications. Why has this become such an important thing to do?
One reason is because a recent study has shown that, after an initial hospitalization, 1 in 5 Medicare patients needs to be re-admitted to the hospital within the first 30 days after discharge. Often, the underlying cause for this readmission is that the patient has been taking his medications incorrectly. Moreover, half of these readmitted patients did not have a follow-up visit with their primary care provider before they were readmitted, where medication confusion or errors due to the transition in care could have been discovered.
Transitions between home, hospital and nursing home or rehab represent a very dangerous time for patients because things can and do go wrong. Somewhere along the line in these critical transitions, medications may not be completely and accurately reconciled or explained to the patient. After going home, the patient ends up taking an incorrect combination of what has been prescribed. Without medication reconciliation, this combination of current medications, prior medications, and over-the-counter medications can interfere with the patient’s recovery or even lead to adverse reactions.
How do these mistakes happen? When a patient is admitted to the hospital the doctor caring for him may have a list of medications from the patient’s primary care provider but also perhaps a second list which the patient carries with him. Often, these two lists are not the same. The admitting physician needs to make the best decision possible at the time to sort out the differences in these lists when she writes the admitting orders. Furthermore, in the hospital, the medications the patient has been taking at home are often changed by the pharmacy to a different medication in the same class. This “auto-substitution” is done only when it will not make a difference in the patient’s treatment and care.
Then, when the time comes to send the patient home, the discharging physician develops a new list of medications. Usually the hospital-based physician reverses the auto-substitutions that took place in the hospital back to the medications the patient was taking at home, possibly adjusting the number of pills to be taken. However, often there are new medications that were added while in the hospital. What can be especially confusing to the patient and his family is that the medications may be written in the generic form rather than the brand name with which they are familiar. This can be confusing because the patient may think that this is a new medication when it is not — the patient may think he still takes the old one from home plus the new one on the list. The result is the patient may inadvertently double-dose himself with powerful medications, sometimes with disastrous consequences.
To try to prevent these dangerous occurrences, health care providers in the hospital and chronic care facility implement the process of medication reconciliation on every admission and discharge. In addition, the primary care provider should perform medication reconciliation during the patient’s first visit back in their office. A more recent development has been to have nurse care managers or clinical pharmacists, working under the supervision of the primary care providers, call the patients within a day or two of discharge and attempt to perform medication reconciliation over the phone.
Whenever a patient finally does get home from the hospital or rehab facility, however, it is important he see his primary care provider within a few days if at all possible. This will help insure that medical reconciliation happens and that the patient won’t end up being the 1 in 5 that is readmitted due to medication problems. It is a good idea to make this visit a “brown bag” visit in which the patient brings in all his medications, new and old, to be sure he is taking the correct medications and correct doses.
So, when your provider’s office staff tells you that you need to have your medications reconciled, be thankful. It means they are trying to take good care of you. Being sure you are taking the medications you are supposed to take, in the correct dose, at the right time is critically important to your health and well being.
Dr. Robert Allen is the executive medical director of Penobscot Community Health Care in Bangor.