😖Have you ever seen the hospital paperwork handed to patients on their discharge⁉️ And you wonder why patients have readmissions back to hospitals 🏥 and often leave confused about what to do next. Polypharmacy is one of my major frustration points for me as a clinician. 💊 Asking particularly elderly patients to manage 5, 10, 15 meds, all with different dosing schedules is one of the absurd parts of modern day medicine. I often make my patients bring in their physical bottles of meds to my appointments to go over how they are actually taking them. What do I find….. 🤔 🔹Missing meds 🔹Two of the same meds (doubling the dose) 🔹Redundant meds in the same class (two beta blockers, etc) 🔹Confusion about direction on bottle 🔹Arbitrarily taking meds how the feel 🔹Voicing of side effects of certain meds There has to be a better way of prescribing and managing meds - but it requires a more hands on approach, then just prescribing another med to “fix” the problem. #valuebasedcare #medtech #dialysis #medicaldevice #healthcare
Erin Dickerson
3mo
It takes time to reconcile and coordinate meds to a doable schedule for the patient, but 100% worth the effort! Not only for reducing readmissions, but for maximizing adherence. When I was a renal RD, I spent many hours assisting patients with medication management, but I truly believe I made a difference in both adherence and overall health. I know everyone's busy, but this is an area worth getting busy in!
Also a major “pet peeve” for me and I try to reduce any un-necessary medication in the renal patients I am consulted on! Often times they will go to hospital, have something like a PPI started for GI prophylaxis during the acute illness, be discharged on it and continued long term with no clear indication. Also when they are on something like lisinopril and the hospital subs enalapril due to formulary and then the enalparil is continued at discharge and as you eluded the patient goes home and starts taking both! I could go on and on with these examples! And sometimes when patient is admitted the med list is pulled from a prior list and not truly reconciled and then it’s an even bigger mess of inaccuracies!
When I did home care nursing, one of my tasks was to visit clients and fill their med planners. Amazon bought a company called PillPack and can mail cellophane strips that contain heat sealed packs of each days meds with a label on the back of each saying what each pill pocket contains. Many pharmacies will fill med planners on a weekly basis for elderly or mentally ill patients as well. This doesn’t address the issue of poly pharmacy though.
it happens with us young pups too. but yeah this is globally an issue
Kerri L. Adkins
3mo
Well said, with the average dialysis patient on 10 - 12 medications a day compliance is a struggle. Thank you for continuing to be a voice for your patients!
Oh goodness- yes!! As a former Pharmacy tech we used to get these med lists in a fax post- discharge. I had an amazing pharmacist who would consult these patients or their family when they picked up. He was thorough. Now- you barely get a consultation on e new med anywhere 🥸. My dad was just sent home with new meds and instructions. I suggested setting up a 14 day pill box so he would not be confused or accidentally take his d meds causing a potential deadly duplication of therapy. This is, however, where hospitals and clinics can implement public health initiatives and actively work to improve poly pharmacy through education and by helping patients to network with the pharmacy.
Televero Health
2mo
It's concerning to see the complexity of medication management, particularly for elderly patients. A more hands-on approach to prescribing and managing medications is indeed necessary. Have you considered the role of behavioral health in addressing polypharmacy, such as counseling patients on medication adherence and providing support for managing multiple medications?
Clinical Manager at Satellite Healthcare / WellBound - ended 11 20.23
3moAnother angle to this story is: there should be time allocated to review post discharged paperwork. The discharge planner should have time to connect with patient information to a primary physician, patient or family member should have patient education esp on medication and follow up. The mindset to make a perfect algorithm requires time allocation and a realization that not having an acknowledgement what patients are taking is like picking up a pill on the floor and taking it- no sane patient will ever do that- so make serious time to read discharge summaries, med changes and know the story what was done while inpatient and follow up. This is from all levels physicians, nurses, dietitians and social workers. The missing link is, time allocation and accountability.