August 16, 2008, 9:17 pm

Do-It-Yourself Medicine Shelf

Does your medicine cabinet look this neat?

Do you even have this many drugs?

My “medicine chest” is in my kitchen. Various and sundry medications and supplements share shelf space with Skippy Extra Chunky Peanut Butter, Smucker’s jelly, Starbucks coffee, Splenda, and CoffeeMate.

I’m ready for nasal congestion, runny nose, nausea, muscle spasms, inflammation, cough, insomnia, diarrhea, indigestion, allergic reactions, superficial boo-boos and headaches.

If I had the appropriate anatomical equipment,  I’d probably be prepared for erectile dysfunction.

And those aren’t even my prescription meds!

Oh, I don’t take them all, but just in case someone has a symptom, I am ready!

Better living through chemistry, that’s my motto!

******************************

Now that the asinine medication reconciliation sheet is an asinine intimate part of the medical record, it’s time to look past the inconvenience, the increase in paperwork and the loss of time at the bedside.

The bottom line is that when you are admitted to the hospital, you are writing your own prescriptions.

The medications you state you take, in the dosages you provide will be ordered, based on the medication form.

This is good, yes?

Only if you are dead certain of what you are saying. Only if you are not writhing in pain and are with it enough to remember all your medications. All of them. Only if you are absolutely certain of your dosages. Only if the list you “always carry” is up-to-date.

If not, then you run the risk of not getting your usual medications in the hospital, getting medications or dosages that were not part of your daily routine or new medications that interact with your old ones.

*****

The whole point of the med rec form is to provide continuity between your pre-hospital, in-hospital and post discharge medication regime.

This wasn’t necessary back in the days of “Marcus Welby, MD”, when your primary doctor followed you in the hospital. She knew you well, knew your family, knew your medical history. Your medical record was the chart in her office, to which she always had access.

Today, you will most likely be admitted by a hospitalist who will coordinate your care and have (possibly multiple) consultants who will deal with specific medical issues. These doctors may or may not know you, and they rely on what is written on the medication sheet to guide their ordering.

They will base your medications on that and they will use the med sheet to avoid medication interactions when they write new orders.

  • That means, if you can’t remember your medication dose, and you guess at it, that guess becomes your dose. Maybe it’s right, maybe not.
  • That means that “I take a water pill, a blood pressure pill, a sugar pill and a stomach pill” will pretty much guarantee that your usual medications will not be ordered, at least in the beginning.
  • That means “my doctor has a list of all my meds” means nothing after office hours because (a) the office is closed and (b) your doctor is probably not on call and trust me, the on-call doc is not going to go to the office and look you up right then and there.

This means that in this day and age, you better have a list, it had better be accurate and it had better be up-to-date and in your wallet (not your wife’s purse or your husband’s papers) at all times.

*****

You would be stunned at the number of alert, oriented, intelligent adults who honestly have no clue about their medications or are so stressed on admission that they cannot remember clearly.

The vast majority of physicians will move hell and high water to find out what you are taking and order appropriately. Then again, some will take that med rec sheet so literally that all they will do is check the “order” box next to what is written: medication names that you provided and medication dosages that you stated

So, it is to your advantage to make it as easy as possible for your hospital health care providers to make sure you receive the appropriate medications.

The majority of this responsibility is now on you, the patient.

Not the doctor. Not your family. Not the paramedic who has to go through your medicine chest.

You.

Make a list of what you take, keep that list up-to-date and keep it with you at all times.

I know it sounds crazy, but under the medication reconciliation requirement, you are essentially writing your own prescriptions when you are initially hospitalized.

Make sure you know what they are.

You health, and your life, may depend on it.

******************************

Major hat tip to my (very) esteemed colleague who actually had the idea for this post and graciously let me use it!

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13 Comments

  • Healthcare Today
    Healthcare Today

    August 16, 2008 at 9:21 pm

    Do-It-Yourself Medicine Shelf // Emergiblog…

    Are you writing your own prescriptions?…


  • annemiek
    annemiek

    August 17, 2008 at 2:14 am

    I keep saying the same thing, whatever you want to be on in the hospital, whatever dose. You want take what narcs? Just add some to your list and you’ll get them.


  • kate
    kate

    August 17, 2008 at 8:16 am

    Amen. I couldn’t agree more; great post. This med recon thing is a PITA and can get us into more trouble than it avoids. Just my humble opinion.


  • Shellee
    Shellee

    August 17, 2008 at 8:37 am

    Yes, hats off! This is an excellent post and so true. The falacy of the current regulatory system strikes again. Thanks for bringing this issue to everyone’s attention.


  • Nurse K
    Nurse K

    August 17, 2008 at 10:36 am

    On our EMR, many clinics in our system are connected, so the physicians enter the meds and they show up on the patient’s e-chart. This reduces SOME of that. However, if that doesn’t apply to you, you have to remember and you put yourself at risk if you don’t remember or have a list.


  • Lisa
    Lisa

    August 17, 2008 at 10:58 am

    Ooooh, I have noticed this before. But a nice reminder that any future hospital visit will include lots of valium and percocet! ;)


  • AlisonH
    AlisonH

    August 17, 2008 at 6:00 pm

    I was told I was not allowed to bring my own meds to the hospital: I had to only take what was brought to me by the staff while I was an inpatient. And even though I got everything recorded right, they didn’t: there were goofs where the hospital pharmacy didn’t have a med on my list or someone forgot to order it and they closed before it got delivered, and where whoever that was supposed to bring it to my room didn’t till I was asleep–you name it. I’ve just figured ever since then that next time, should there be a next time, I just bring my own and figure out a way to humor the hospital as needed but basically forget them: I’m on my own.


  • AlisonH
    AlisonH

    August 17, 2008 at 6:05 pm

    Just to clarify: I would comply with their rules as best I can, but if they don’t bring or don’t have my med, that way I have my med, I can take it on time, I tell them I have it and I tell them when I’ve taken it. Done.


  • Mother Jones, RN
    Mother Jones, RN

    August 18, 2008 at 7:51 am

    Drug addicts tell me, “I take Ativan 2 mg pills 6 times a day. And then I take Percocets around the clock. Really! So, is the doctor going to give me my meds?” Sometimes those stupid medication reconciliation sheets are entertaining.

    MJ


  • ernurse
    ernurse

    August 18, 2008 at 8:36 am

    Excellent post!! This should be an article in the paper or something like that because so many people are on prescription meds for one thing or another nowadays.

    When we discharge pts at my ER we give them a sheet with the list of meds they told us they take, dosages, route, frequency and all, and we tell them to go home and compare it with their meds, update it and keep it somewhere safe to bring it with them next time. Most of them never do.


  • Jessica Bern
    Jessica Bern

    August 19, 2008 at 11:00 am

    My darling. I volunteer in an ER and you could not be more correct. I love your blog. I am now officially a subscriber. thanks for all the great info.


  • Donna B.
    Donna B.

    August 19, 2008 at 8:50 pm

    I started keeping a medication list in my purse several years ago and make one for my husband also. He’s not as good at keeping it on his person as I am.

    For me, this was a way to save time when visiting the doctor. I give them the med list, the “current” complaint I have and anything else I want them to know in writing. Almost everyone can read faster than I can talk.

    What I want now is a standardized patient information sheet I can fill out ahead of time. I’m talking about name, address, contacts, insurance, and past surgeries. I realize each type of doctor has a need for different information, but that one sheet done ahead of time would be great.

    This is needed to increase face time and physical exam time with the doc. I also absolutely love the docs who have a nurse in the room documenting the conversation so the doc can focus on the patient for the allowed 7 minutes or so.

    Thanks for the rant space!


  • PharmacistMike
    PharmacistMike

    August 21, 2008 at 11:50 am

    The Med Rec sheets are a great idea in principle. Comparing med lists as the patient moves through the health care process. The problem is that they are taken as the world of God and unfortunately already tax the nursing staff. I have long said that the recon process should be managed by pharmacy. They can easily notice discrepancies, contact the patients pharmacy and decide what needs immediate clarification. Unfortunately, pharmacy administration refuses to step up to the plate.

    Years ago my grandpa decided to stop taking all of his meds after he was discharged from the hospital. The problem is that the hospital sent him home on things he didn’t need (i.e. ulcer prophylaxis, etc). Recon. of his prior meds we were able to reduce his pill burden and that led to him being compliant.

    Too bad this entire process has been dumped on nursing.


About Me

My name is Kim, and I'm a nurse in the San Francisco Bay area. I've been a nurse for 33 years; I graduated in 1978 with my ADN. My experience is predominately Emergency and Critical Care, and I have also worked in Psychiatry and Pediatrics. I made the decision to be a nurse back in 1966 at the age of nine...

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