Spring Cleaning Your Patients' Medicine Cabinets

In past columns, I have explained the many counseling opportunities for community pharmacists. Pharmacists working in hospitals have similar counseling opportunities. For example, medication reconciliation is a form of brown bagging and medication therapy management (MTM). Both can be used to advance communication and to prevent errors. As with an MTM session, medication reconciliation helps ensure that a patient’s medications are accurate and safe. By relying on medication reconciliation, hospital pharmacists can prevent errors that occur when a patient’s medications include prescription and/or OTC drugs and herbal and/or dietary supplements. The process allows for checking omissions, duplications, dosing errors, adherence, and drug interactions. In all, the services provided by an inpatient or outpatient pharmacy team enhance communication between the provider and the patient.

Brown Bag Consult

SU is a 46-year-old woman and regular shopper at your pharmacy. Even though SU is a veteran and gets most of her medications filled at the pharmacy inside the city Veterans Affairs (VA) hospital, she still relies on your pharmacy. It is more convenient for her family’s needs, and she and you have established a trusting relationship. SU was diagnosed with depression about 10 months ago and is continuously facing many personal and professional ups and downs. SU comes to your counseling window and presents a list of medications and current laboratory data from a recent doctor’s visit. SU explains that she was recently at the VA hospital for some appointments from which she left confused and frustrated. She complains, “No one listens to me. I have all these papers, and I have no idea what I’m actually supposed to do. Instead, I just get more and more medications.”

You can see that SU appears tired and anxious. You look through the papers and notice the medication reconciliation performed by another pharmacist. You review it against SU’s profile at your pharmacy and notice some changes. As you conduct your review, you see the concern in SU’s face. You explain the concept of pharmacy brown bag and MTM sessions and ask if she would be interested. SU is relieved and informs you that she will bring in all her medications the next day. SU is looking forward to going over her entire history and current medication list. She appreciates your listening and your willingness to help her get back on the right track. You suggest that she come in around 2:00 pm, which is a slower time at your pharmacy. This will allow you to provide her with the best service and care.

The next day, SU arrives at your consultation area. You have done your homework and reviewed SU’s profile. You have access to the VA hospital laboratory data and medication reconciliation. You compare your information with what is in SU’s brown bag:

• Atorvastatin 40 mg daily
• Niacin dietary supplement
• Lipitor 40 mg daily
• OTC omeprazole 20 mg daily
• Ondansetron 4 mg as needed
• Lorazepam 1-2 mg as needed
• Sertraline 50 mg twice daily
• Citalopram 40 mg daily
• Duloxetine 60 mg daily

Pharmacy profile (after reviewing medication reconciliation and VA hospital papers):

• Atorvastatin 40 mg daily
• Niaspan 500 mg daily at bedtime
• Atenolol 25 mg daily
• Escitalopram 10 mg daily
• OTC multivitamin daily

The goal of a brown bag session is to discover discrepancies, awareness of which can allow you to make several short- and long-term suggestions. Your advice may improve communication between SU and her providers. This may improve SU’s quality of life and reduce her risk for hospital admissions. SU is willing to have you act as a community liaison between her and her providers. The first step is to follow up with SU’s providers. Make them aware of your brown bag session discoveries and the suggestions you have regarding SU’s plan of care. Taking time to do this may be the biggest challenge, but it is important to incorporate clinical opportunities like this into your workflow. Patient loyalty and satisfaction are worth the energy to help SU.

What questions and suggestions do you have after reviewing SU’s brown bag medications? What laboratory data might have helped you when you reviewed SU’s medications?

SU definitely needs more counseling and follow-up care in the community pharmacy. Considering your time restrictions, how can you help ensure that SU stays on your suggested track toward better health? Stay tuned…

Dr. Drury works as a clinical pharmacy specialist in Chicago, Illinois, and Milwaukee, Wisconsin. She earned her doctor of pharmacy from Midwestern University College of Pharmacy. Her blog, Compounding in the Kitchen, appears on www.PharmacyTimes.com.