As home care nurses know, helping a person in the community manage their medications can be a daunting task. When a patient is transitioning from the hospital or community into home care, the chances of error increase especially if there is a change in the regime. There are so many variables that need to be addressed.  These include the hospital discharge list, the prescriptions, and bottles of prescribed and over the counter medicines in the home. Another significant document, however, is the patients own current medication list.  Having a personal list is especially important for those patients who have multiple chronic conditions and are managed by several different prescribing physicians.  When a current medication list is available, it makes the reconciliation process clearer and easier to identify potential problems.  At times however, one is not available.

One patient I visited was a 66 year old woman that had been discharged from the hospital with a diagnosis of CHF and HTN.  There were 15 assorted bottles of medications in the home, and a majority of those had been prescribed within the past two months prior to hospitalization. The hospital discharge form also listed medications that were different from the prescriptions she had received at the hospital pharmacy. When reviewing the medications prescribed prior to the hospitalization, it was discovered she had both the brand and generic form of two of her medications, written by two different physicians, and filled at two different pharmacies.  An hour later, after verifying with the primary physician, we were able to reconcile her medications, and in the end, she was “only” on eight medications. She wrote these out in a list (and included generic and brand name for clarification), along with the dosage, times to take, prescribing physician and the reason she was taking the medication. She also decided on one pharmacy to use, so the pharmacists there would also be aware of what she was taking and decrease confusion.

Another patient was a 62 year old woman with a diagnosis of diabetes, HTN, COPD, CAD and depression. She was taking 22 different medications; a combination of oral meds and inhalers. Luckily she knew the importance of creating and maintaining a list of all her medications, and in fact she had two lists!  One was kept posted in the home, the other she would bring on her many physician visits.  Any changes were then updated on both forms.  Just the process of writing it out, which she did with her son, helped to increase her knowledge and understanding of what she was taking and why. It empowered her in taking charge of her health and it helped the many physicians working with her to know what she was taking.

As the population ages and people are placed on more medications for different chronic illnesses, creating and maintaining a medication list cannot be over emphasized.  Home care nurses are invaluable in helping patients achieve this goal.  For those patients who do not currently have a medication list, the process of writing out what they are taking can help them on their way to a better understanding of their medicines. It is essential to convey to the patient that a list is not static, and the significance of keeping it current.  It can change over time and especially at hospital discharge, when medicines may be tweaked and fine-tuned.

The CHAMP website has some great tools that can help home care nurses with the reconciliation process, and tools to be shared with patients to help them create and maintain a medication list.  Let us know how this has helped you in your practice.