Medication Review

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

  1. Patients
    demographics

  2. Social
    history

  3. Presenting
    complaints

  4. Past
    medical history

  5. Allergy
    and sensitivity status

  6. Current
    and recent medication

  7. 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

  1. Untreated
    indication

  2. Improper
    drug selection

  3. Subtherapeutic
    dose

  4. Overdosage

  5. ADRs

  6. Failure
    to receive drugs

  7. Drug
    interactions

  8. 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

  1. Case
    notes

  2. Observational
    charts

  3. 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

 

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