In the Spotlight
Check Your Medications: A Prescription for Better Health
Contributed by Rosemary Grealish, Pharmacy Program Manager
I recently had the chance to go with my father to an appointment at his VA Medical Center. My dad is an 88-year-old WWII Veteran, still living independently. Like many other Veterans, he has two outside providers; a primary care geriatrician* and a cardiologist**. When I picked him up in the morning, he had his list of medications (PDF) that he always carries
When we checked in at the clinic, my dad said that the clinic's list of his medications was right, but I noticed that he had Vitamin D tablets listed as a non-VA med. He did not remember Vitamin D and was not taking it, so we planned to ask his provider about it.
When we saw the provider, a young physician new to the VA, one of the first things she did was ask my dad about his medications and if he saw any other providers. She updated the information in the Electronic Health Record, noting the names of the non-VA providers. She asked if all the medications were correct, and when my dad said "Yes," I reminded him about the Vitamin D. Before she removed it, she checked the original entry. She found that one of his previous VA providers wanted to order it for him, but to save money on the co-pay, he said that he would buy it over-the-counter. Then he went home and promptly forgot about it. She suggested that he take Vitamin D, and offered to include it with his other medications. He agreed, so she removed the non-VA entry and entered the new order in the Electronic Health Record. His provider reviewed all his other medications with him, and also offered to share the list with his non-VA providers. The rest of the visit went normally.
When we returned home, I asked Dad to show me his medications and tell me how he was taking them. I was upset to find that there were two huge problems. The prescription for two of his medications clearly said "Take one-half tablet twice a day," yet he never split them into halves. Having thrown the pill bottle away, and not referring to his medication list, he was taking whole tablets every evening (no wonder he kept running out!).
I set about creating a new system, until my mother said it would be better to leave things in his original, 7-section pill minder. When I tried to explain that a monthly pill minder would make it easier for him to keep track of, she said that he is set in his ways. She would rather keep things the way they were. If you have had any experience 'reasoning' with elderly parents, you know when you have reached an impasse. The 'compromise' was to allow my dad to keep his precious 7-day pill minder, but he had to promise to keep all the pill bottles. I relabeled the pill minder to include the strengths of the medications. I also put the names of his medications on a card, and pasted the corresponding pill (or half pill) on the card so that he will have an example when he lays out his pills every morning.
I am a pharmacist. As it happens, I set up the Medical Reconciliation process at my father's VA Medical Center a while back, and I am happy to say that it is working as intended. I am especially impressed that a new doctor was so well-trained in the process. I have been gone from the medical center for about six months. It is good to know that the process we put into place three years ago is still used to provide excellent patient care. Could it be improved? Yes. The process at his medical center worked. We have found that Medical Reconciliation goes beyond a list. It must be part of talks between the health care team, the patient and their caregiver.
It took some give and take, but I got my parents on board!
* geriatrician - a doctor who specializes in the study of the elderly. They focus on promoting health and treating diseases of people who are age 80 or older.
** cardiologist - a doctor who specializes in the study of the heart. They focus on preventing and treating diseases of the heart.
Updated/Reviewed: December 1, 2010