A Proper Meds Management Primer
Medication management is a significant process to maintain and/or improve overall patient health status. Proper and continued training must be implemented so that all medical professionals are continually educated with updated processes.
All healthcare providers must follow a comprehensive set of actions to ensure safe practices are in place from the beginning to the end of the process from the time a prescription is ordered through hand-written entry or electronic transmission, accurate transmission via phone call, fax or e-scribe, proper labeling and dispensing, correct administration, and to the real time documentation of medication taken. Providers, staff, patients, families and caretakers may all be involved in the medication management process, therefore giving the multiple opportunities where system break-down may occur.
Order entry and transmission for new prescriptions and prescription refills with changes, in essence, a new prescription, should be completed by physicians or advanced practice professionals certified to prescribe. With thousands of look-alike, sound-alike medications available, it is very easy to inadvertently say or electronically select a wrong choice which ultimately puts the patient at high risk most commonly for wrong medication, wrong dose, or wrong frequency.
A thorough medication history taken at each visit will minimize common risks of failing to assess or review allergy status, medication reconciliation among prescriptions from other providers, and medication interactions. Patients do not always consider over-the-counter, homeopathic, supplements or natural remedies to be medications, therefore, questioning for usage of these products is important. Whether using paper or electronic systems, updating medication start and stop dates is necessary for viewing an accurate patient medication profile.
When giving medication, regardless of type, the six rights must always be followed:
Right Person/Right Medication/Right Dose/Right Time/Right Route/Right Documentation.
Each time a medication is given, a “three check” system should be followed to make sure the six rights are present. This involves
removing the medication from the medication area and checking the prescription label against the medication log to make sure they match as the first check.
Before pouring the medication, checking the prescription label against the medication order to make sure they match as the second check.
After pouring the medication, but before giving it, checking the prescription label against the medication log entry again to make sure they match as the third check.
Frequently patients are given samples of medications before filling a prescription. Patient education may directly affect responsiveness to the prescribed medication. A written information sheet with directions on how to take the medication may enhance the patient’s ability to follow verbal directions given at the visit. Acknowledging patient understanding and health literacy through techniques as patient demonstration and "speak-back" may facilitate proper self-administration techniques and achieve desired outcomes.
Proper monitoring of medication activity with followup as periodic exams, labs and other diagnostic tests, and review of self-monitoring assessments as blood pressure and blood sugar logs is essential to evaluate patient responsiveness.
Awareness of resources as CURES (Controlled Utilization Review and Evaluation System) for controlled substance patterns will also assist in monitoring patient usage of Schedule II-V drugs.
With over 4 billion prescriptions written in the U.S. in 2012, a team approach to safe medication management systems must be followed from prescription ordering through order transmission, preparation, administration, and documentation. Breakdowns in any area of medication management is a leading cause of patient adverse events, and avoidable when risk management and patient safety concepts are strictly followed.
Jacqueline (Jackie) Gellis-Server is a senior risk management and patient safety specialist for the Cooperative of American Physicians in Los Angeles. This is the second in a six-part series about patient management issues from CAP.
