Medication
Review
Content
• Role
of medication review in patient care
• Components
of medication review
• Types
of drug related problems
Objective
After completion of this session, student will be able
to:
• Explain
the role of medication review in patient care
• Outline
the components of medication review
• List
the types of drug related problems
Introduction
• Medication
review involves review of a patients medication regimen to ensure that therapy
is safe, appropriate, efficacious and cost effective
• This
can be achieved by pharmacists attending ward rounds on a day-to-day basic and
applying their knowledge of therapeutics
Goal of Medication review
• Optimize
drug therapy and patient health outcome by identifying and solving drug-related
problems and
• Ensuring
that all therapeutic objectives are being achieved
Significance of Medication Review
Daily review enables
a) Assess
whether desired therapeutic outcomes are being achieved
b) Monitor
for drug related problems
c) Ensure
rational and quality use of medicines
d) Assess
patient compliance
e) Assess
the completeness of medication charts
Components of Medication Review
• Medication
order review/ Treatment chart review
• Clinical
review/ Daily progress review
• Detection
and management of ADRs
Medication order review (MOR)
• It
is a systematic review of a patients drug therapy to ensure that the prescribed
medication is appropriate for the patient
• This
involves the assessment of all current and recent medication orders, including
routine medication and OTC and use of other systems
Goal of MOR
• To
optimize the patients drug therapy by ensuring that patients receive the right
drug, dose and dosage form for the right duration
Steps in MOR
• Collection
and interpretation of patient-specific information
• Assessment
of therapeutic goals
• Identification
of drug related problems
• Individualizing
medication regimens
• Monitoring
of treatment outcomes
• Medication
chart endorsement
• Documentation
Collection and interpretation of patient-specific
information
- Patients
demographics - Social
history - Presenting
complaints - Past
medical history - Allergy
and sensitivity status - Current
and recent medication - Lab
investigations
Sources
• Patient
• Case
notes
• Observational
charts
• Lab
results &
• Discussions
with medical and nursing staff
Medication history interview
• Sometimes
medical staff may collect incomplete or inaccurate information about drugs
• Medication
history interview (MHI) is defined as obtaining accurate information on
patients’ medication use that may assist in the overall healthcare of the
patient
Goal
- The
ultimate goal of medication history interview is to individualize the
medication order to ensure the rational drug use. This can be achieved by:
§ Gathering
the accurate and relevant information on medication use
§ Comparing
the obtained information with the information collected by the other healthcare
professionals (medication
reconciliation)
Significance
It enables the pharmacists to:
§ Establish
the rapport with the patient
§ Explain
their role in the patient management
§ Conduct
preliminary medication counseling
§ Plan
the ongoing patient management / pharmaceutical care
Aspects to be assessed
·
History of previous allergies and/or ADRs
·
Indication / purpose of drug use
·
Dosing regimen
·
Perceived efficacy of each drug
·
Perceived side-effects/ allergies to medicine
·
Adherence to drug regimen
·
Potential drug – drug or drug food interactions
·
Drug administration techniques
·
Use of medication aids
·
Use of prescription and /or non-prescription
medications
·
Specific problems relating to medication use
·
Immunisation status (if relevant)
·
Possibility of pregnancy in women of
childbearing age
·
Social drug use (alcohol, tobacco, pan masala
etc)
·
Evidence of drug abuse
·
General attitudes towards illness and medication
use
·
Treatment with other system of medicines (e.g.,
Ayurveda, Siddha and Unani)
Assessment of therapeutic goals
• Cure
of the disease
• Reduction/elimination
of signs and symptoms
• Arresting
or slowing disease progression
• Preventing
disease/symptoms
• These
goals should be tailored to the patients individual circumstances and may
differ from patient to patient
Identification of drug related problems
• A
drug related problem is an event or circumstance involving drug treatment that
interferes with patient achieving optimum outcome of medical care
• Eight
categories of drug related problems were outlined
Drug related problems
- Untreated
indication - Improper
drug selection - Subtherapeutic
dose - Overdosage
- ADRs
- Failure
to receive drugs - Drug
interactions - Drug
use without indication
Individualisation
Individualising Medication Regimens
• This
is important for patients with chronic diseases who are on many drugs on a long
term basis
• The
main aim is to simply the regimen as much possible and to adjust the regimen
for long term medication adherence
These include
• Switching
to slow release formulations of same drug
• Using
a different route of administration
• Changing
the time at which doses are taken
• Switching
to cheaper but effective and safe medication
• Combination
formulation to replace two drugs
Monitoring of Treatment Outcome
• This
is the key to assess whether the therapeutic goals of drug treatment have been
achieved
Involves review of
- Patients
clinical status, - Laboratory
data - Other
markers of drug therapy response
Disease or condition | Some common outcome parameters |
IHD/Angina | Occurrence of angina/B.P/Heart rate |
DM II | Blood glucose levels, Body weight,HbA1c |
Acute Gout | Uric acid levels,Pain,Redness |
Medication Chart Endorsement
Medication Chart Endorsement
• Chart
endorsement is one of the primary responsibilities of the pharmacist in ensuring
that medication orders are unambiguous, legible and complete
• It
is important to avoid medication errors
Examples
• Is
the identity of the patient (name and medication chart) on each medication chart?
• Is
the allergy status of the patient documented?
• Is
the medication name clear? (AZT)
• Is
the drug prescribed by the generic name?
• Is
the dose clear? (units)
• Is
the route, time and date of administration clear?
• Is
a minimal dose interval stated? (paracetamol)
• Are
additional dose administration instructions given when appropriate? (Aspirin)
• Is
there any over writing?
• Has
the medication chart signed by a nurse each time a dose was due?
Documentation
• The
pharmaceutical care provided by the pharmacist should be an integral part of
the patients medical record
Daily progress review/Clinical review
• Clinical
review is the review of the patients
progress for the purpose of assessing therapeutic outcome
• Should
be performed on daily basis
Goals
• Assess
the response to drug treatment
• Evaluate
the safety of the treatment regimen
• Assess
the progress of the disease and the need for any change in therapy
• Assess
the need for monitoring, if any
• Assess
the convenience of therapy
Procedure
• It
should be done daily for all the patient
• It
is carried out every day by attending ward rounds
• To
evaluate patients response, we need to review biochemical, hematological,
microbiological and other investigations
Sources
- Case
notes - Observational
charts - Discussion
with patient and health care professionals
• This
data should be interpreted to assess whether or not progress is being made
towards the targeted objectives
Summary
• MOR
is a systematic review of a patients drug therapy to ensure that the prescribed
medication is appropriate for the patient
• MHI
is defined as obtaining accurate information on patients’ medication use that
may assist in the overall healthcare of the patient
• Clinical
review is the review of the patients
progress for the purpose of assessing therapeutic outcome
