By Nath Arwa and Katu Mutungi, Clinical Pharmacists at Aga Khan University Hospital
At one point in your life, you may have used medication. Did you stop to think whether that medicine was safe for you to use? Did you question the choice? Were you asked if you have an allergy? Were you told how to store the medication? These among other considerations are some discussion points that you should have with your pharmacist before taking any medication. This is essential to ensure medication safety. Medication safety is freedom from preventable harm with medication use.
It is important to involve patients in decisions about their medicines as this increases the probability of medicines being used appropriately. Good communication (with patients and care givers, and between health and social care practitioners) and good practices when prescribing medicines can help patients to have a more active role in their treatment and reduce any shortcomings.
A multidisciplinary team of professionals including doctors, nurses, pharmacists, pharmaceutical technologists and specialists, may be involved in prescribing and managing patient’s medicines. These professionals should have the relevant knowledge and skills to assist patients with their medicines. Social workers may also be involved in the care of patients.
Healthcare providers should talk to patients about getting the most from their medicines and explain any necessary support they can be offered to enable them make informed decisions. The Patients’ family or care giver can be involved in helping the sick make decisions as well, with the patients’ approval especially where children and the elderly are involved. They can have a discussion with their pharmacist about the different treatment options, how the medicines are likely to benefit them, and any anticipated side effects. Healthcare providers should use the best available evidence when discussing medicines with patients. They should also ask patients what is important to them about managing their condition and their medicines, and consider patient values and preferences when making a decision about treatment.
Healthcare professionals may suggest using a patient decision aid tools to help patients. This tool can be used during an appointment to help patients weigh the risks and benefits of treatments depending on their health, lifestyle and preferences. More than one appointment may be necessary before a treatment option is selected. A patient should be able to talk about their decision again and be able to change their mind, particularly if health or circumstances change.
It is important that healthcare professionals have an up-to-date list of all the medicines patients are taking. This is particularly important if patients are admitted in hospitals, if they are transferred to a different hospital, and when they are discharged from hospital.
During transitions of care, it is important that relevant information about patients’ medicines, and a list of medicines they are taking, is discussed and shared with them, their family members or care givers. Relevant information about them and their medicines should also be shared between health and social care practitioners involved in the care process. This ensures that everyone involved in the patient’s care has the information required to help prevent mistakes with their medicines wherever possible. Patients (or their family or care givers) should be given a complete and accurate list of their current medicines in a format that suits them. The list should include any changes to their medicines, if any, made during their hospital stay.
In the case of patients taking several medicines, those who have a chronic ailment, or the elderly, a healthcare professional may arrange a meeting with them to discuss whether they are getting the best from their medicines. The patient’s family members or caregiver may be involved in this meeting where necessary. The support could also include advice from a pharmacist, telephone support, or home visits from their doctor or a nurse. The review session allows a pharmacist to check all the medications that a patient is taking, confirm that the patient knows the reason for each medication and confirms that the patient does not have a medication related problem.
If patients have chronic conditions and they want to be involved in managing their medicines themselves, their healthcare provider may discuss with them the benefits of using a self-management plan. This plan empowers patients to take charge of their health. It gives them all information about their treatment plan. They are taught to look out for any warning signs and told when and how to seek advice from a healthcare provider. This plan is provided in a format that is suitable for patients, and is reviewed regularly.
Health professionals should pay attention to special populations such as patients with kidney diseases, the elderly, young children, critically ill patients, expectant and lactating mothers whose doses frequently need to be change due to the unique way their bodies handle medication. Failure to adjust their doses may lead to patient harm. Pharmacy staff through the concept of therapeutic drug monitoring, can facilitate appropriate dose adjustments to ensure optimal treatment outcomes. Hospitals should embrace this concept to promote safe medication use in special populations.