Happy New Year! For this first blog of a new year and new decade, I thought I’d share a personal experience that once again reinforced the importance of good medication management. Recent CHAMP participants have heard about my 83 yr old mother whom I present as a real life example of potential medication-related problems.
A few days before Christmas, my mother was admitted to hospital with what she thought was a stroke and fortunately turned out to be a TIA. During hospitalization, her cardiologist decided to insert a pacemaker and then put her on Plavix with low dose aspirin 81 mg. I contacted him regarding my concern about this combination with her history of GI bleeding from aspirin at a higher 325mg dose. He was open to taking my call, and briefly discussed the risks/benefits of this combination to prevent stroke. (By the way, my mother had recently changed to this provider after a challenging relationship with a previous cardiologist who treated her with condescension.)
At discharge, the nurse reviewed the medication regimen and new prescriptions with mother and me. However, it soon became clear that a thorough medication reconciliation process had not taken place: Lisinopril, newly ordered by the ER MD, but not her cardiologist, was on the discharge list. My mother asked why she should take it, since previous blood pressure medications were to be resumed. Also, Plavix® was on the list, but not the aspirin he had discussed with me. The cardiologist was available to clarify the orders; he discontinued Lisinopril and clarified that she should take Plavix® without aspirin.
What did I learn from this experience? It reinforced the critical importance of a good medication reconciliation process at a transition in care; that patients and family should be encouraged to ask questions about their medications; and that providers-especially new ones- can be open to discussion about history of adverse reactions when a regimen includes potentially significant drug-drug interactions like Plavix ® and aspirin.
Dennee Frey, CHAMP Pharmacy Expert
Thank you, Dr. Frey, for this entry. It is essential to have not only the patient but also a family member understand and ask questions about medication reconciliation. Your background certainly was a huge asset in your mother’s case. Most family caregivers need a lot more help than they get. At the United Hospital Fund, our Next Step in Care website –www.nextstepincare.org–has a guide for family caregivers to help them provide relevant medication history, understand medication interactions, and avoid errors. There is also a guide for providers on how best to explain this process to family members. Carol Levine