Page 33 - The SA Journal Diabetes & Vascular Disease Volume 9 No 4 (November 2012)
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VOLUME 9 NUMBER 4 • NOVEMBER 2012
175
SA JOURNAL OF DIABETES & VASCULAR DISEASE
MEDICATION REVIEW
TESTS AND MONITORING
It is essential to assess disease control by asking the patient about his/her
symptoms and measuring relevant clinical parameters such as blood
pressure, pulse, weight etc. Check results of recent blood or urine tests
that have been arranged to monitor the patient’s condition and their re-
sponse to prescribed medication. Based on these results, are any condi-
tions under- or over-treated? Use an appropriate reference, such as the
British National Formulary (BNF), for advice on monitoring tests and
how to adjust medication in response to results.
EVIDENCE AND GUIDELINES
It is essential to ensure the patient is receiving the best possible treat-
ment based on latest evidence and guidelines. Ask yourself:
Is what we are doing in line with current guidelines?
•
Have the guidelines changed since the patient’s last review?
•
Are any of their prescribed drugs now considered to be less suitable?
•
Are we using the best dose?
•
It is also important to check whether any changes have been made to the
patient’s medicines by the hospital following an admission or out-patient
appointment. In addition, consider whether any other investigations are
now advised.
ADVERSE EVENTS
Troublesome side effects or adverse events can obviously be a reason for
a patient deciding to stop taking medicines, or to take them less often
than recommended. Therefore, it is very important to ask about whether
any side effects have been experienced. Take care not to misinterpret an
adverse reaction as a new medical condition.
If side effects are a problem, discuss how the patient would like to deal
with them. The NICE guideline recommends discussing the benefits, side
effects and long-term effects of treatment to allow the patient to make
an informed choice. Options include adjusting the dosage, switching to
another medicine with a different side effect profile and other strategies,
such as changing the timing of taking medicines.
For patients taking multiple medicines, check for potential interactions
or duplications and ensure there are no contraindications to the patient’s
medicines.
RISK REDUCTION AND PREVENTION
Use a patient’s medication review to update opportunistic screening (e.g.
asking about smoking status and alcohol consumption) and if needed,
provide appropriate lifestyle advice and support. What additional risks are
there, such as falls, bleeding or hypoglycaemia? Are the patient’s drugs
optimised to reduce these risks?
SIMPLIFICATION AND SWITCHES
Keeping drug regimens simple can really help to improve adherence. At
Physical
•
Use a written schedule of the different medications, when and how
often they should be taken and any special directions. Make sure the
schedule is kept updated with any changes
•
Encourage the patient to take the medicines at the same time each day,
using a diary, calendar, medication administration record sheet (MARS),
pre-filled dosing box or set a mobile phone alert to act as a reminder
•
Keep medicines in an obvious place so they will be noticed
•
Keep prescribing simple. Consider using once-daily preparations or fixed-
dose combinations to reduce the number of tablets to be taken
•
Consider prescribing medication in a liquid form for people who have
difficulty swallowing
•
Work closely with pharmacists – they will pre-fill medicine boxes, and
deliver repeat medication to those who have difficulty accessing their
medicines
•
Encourage patients to be involved in monitoring their own condition and
to request repeats before they run out
•
Remember that patients have the right not to take the medications we
recommend if they wish
Tips for helping patients and their carers to
improve concordance
the medication review consider whether the treatment could be simpli-
fied, perhaps by changing to once-daily dosing and combination thera-
pies (combining more than one medicine in one tablet). Always check the
patient is being issued with the correct number of tablets or volume of
liquids to cover the prescription period. Explain any switches that have
been introduced as part of efforts to improve the cost-effectiveness of
prescribing.
RECORD KEEPING
Ensure that you Reed Code and document a patient’s “Medication Review”
in their records. Remember to highlight particularly important issues – it
will make the next review easier and may be important medico-legally.
Authorise the appropriate number of repeats. Set a recall date for the
next review with any blood or urine monitoring to be done beforehand.
MEDICO-LEGAL RESPONSIBILITY
Remember that, whatever the views of the patient and whoever con-
ducts the medication review, responsibility for prescribing lies with the
person signing that particular prescription. If you feel unsure about a
particular medication, the dosing or interactions with other drugs, seek
further advice.
NICE clinical guideline 76. Medicines adherence. 2009.
•
British National Formulary
•
Lewis, T. Using the NO TEARS tool for medication review.
•
BMJ
2004;
329
doi: 10.1136/bmj.329.7463.434
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