Medication Reconciliation – Why it’s important to you

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Medication reconciliation can keep you safe.

Have you heard the term ‘medication reconciliation’? Probably not, it’s an insider’s term within medicine. But it’s an important concept, and I want you to know about it. I want you to ask about it any time you find yourself going into the hospital, going to the emergency department (ED), coming out of the hospital, going into rehab, switching doctors, having any major changes in either your health or who is monitoring your medications.

The term medication reconciliation (abbreviated ‘med rec’) means taking your whole medication list and understanding, how you are taking it and when you are taking. It is about making sure that information goes with you any time you are making a transition. So ideally, at the moment you enter a hospital someone figures out exactly what you take, how you take it, and when you take it. It is awesome if you come with this information. You could carry that information with you and have it ready to share with your health team. It is a huge safety factor in your care. If they know exactly what you take, how you take it, when you take it, they will make much more informed decisions in your care. This is true in the emergency department, the hospital, moving to rehab, moving to assisted living. I applaud the pharmacists who do this well in hospitals, clinics, and other settings around the country.

If you come in with it ready, you have saved them a lot of time and effort. And, you’ve helped assure your own safety. This important information will help guide the next phase when they will make any modification depending on why you are in the health system and what your needs are at that time.

If you’re in the ED or the hospital for a particular reason, there may very well be a need for a new medication to treat the reason you’re there. It is important that any of those changes are communicated all throughout your stay within and beyond the health system.

Formulary

A little caveat that’s important is another important term to understand – formulary. There can be a number of different medicines that do the same thing. We call them medication classes, and each class could have several medications that do the same thing in the same way. Rather than carry every medication on the market, a hospital will carry a few in each category.   It is possible that the one you typically take is not on their formulary. They will switch you while you are in the hospital to one that is on their formulary. The name, color, and size might not look familiar to you. Be sure to ask questions when you don’t recognize your medicine. This is not harmful; it will not put you in danger. Medicines within the same class work the same way as the one your doctor had you on at home. But, it is a source of confusion when you go home or move to another part of the health system. It’s one of the reasons this medication reconciliation process is so important.

It is critical that you know that another medication, similar to the one you take at home, is being used in the hospital. You want, when you go home, to be switched back to the medicine you came in on, the one that was prescribed by your own primary care provider.

Many, many patients have run into difficulty when they go home on the medication the hospital gave them and they continue to take the one they have at home. This is called duplication of therapy. You are getting twice the amount you need – you have the one you have at home and the on the hospital gave you that do the exact same thing. So, using blood pressure as an example, if you are taking the medicine you have at home plus the one in the same class that you got in the hospital, you could lower your blood pressure too much. You want to avoid duplication of therapy; be sure for that class of medicine you are on just one.

Be sure to ask at the hospital if you can go back on the one you were familiar with at home that does the same thing as the one you got while in the hospital.

It is important that several people know exactly the medicines you take when you go back home or get to your next destination. You are one of them, of course. It is also important that anyone involved in your care such as your spouse, child, or caregiver involved in your care; your primary care doctor; any specialists; and your pharmacist know exactly how your medications have changed while you were in the hospital.

It is important that any intermediate step before you go home, such as rehabilitation, knows your entire current medication regimen. But, it is most important that you understand exactly what to take when you get home.

Medication changes while you’re in the hospital

What if problems related to your medication led to you going to the hospital? That is very often the case. Then, the medicines that led to your admission will be stopped or changed. If the problem that took you to the hospital was something new, then it’s likely that new medicines were added to your regimen. Again, it is important that you know what changes were made, why they were made, and exactly what you should do when you get back home. Ideally, ask your questions while you’re in the hospital, but if you get home and have questions, don’t hesitate to reach out for answers.

Medication reconciliation is something we often do at Meds MASH. People get home and realize they don’t really understand what they are to do. They have a list from the hospital, a list from rehab, and their home list. They wonder if anyone has looked at all of the medicines – the old ones, the new ones, and some from other doctors.   At Meds MASH we look at all of the medicines and make sure they are all safe together. We catch those duplications and clear them up with your doctors. One of the things we will do, with your permission, is get information from all of your doctors and from the hospital and pull it all together. Then, after the thorough analysis, any changes will come from your primary care doctor who is the gatekeeper and the one person responsible for all of your medicines.

Three doctors recently wrote an important article about the need for accurate medication reconciliation. And they note that this process must be thorough to be meaningful. Several partial versions have been tried, and if it isn’t complete, it’s not helpful. It’s not going to keep people safe if it is not done right.

If a thorough medication reconciliation can keep you safe and healthy, please contact us at Meds MASH at 410-472-5078 or www.medsmash.com/contact.

BIBLICAL APPLICATION

This Biblical application might feel a little less associated with the health part. With medication reconciliation we are talking about making sure all of the information related to medication use is clearly communicated. If it is not done completely it isn’t effective. What about our compassion and how we reach out to others? How complete and effective are we?

Something has been weighing very heavy on my mind in the last week. It is the decisions we make about where our compassion lies. Who we can forgive and who we can’t. How do we spend our money and give our support and where we do we not? The thought that has been raised in my mind is – when we know someone is in need, and we do not know their sins, it seems to me it is easier to reach out and provide support for those needs. The example that got me thinking this is the refugee crisis. When you know there are millions of people who have been displaced, a lot of people have compassion for that and for their circumstances. What can we do to help those people and their dire circumstances?

The other things that made me think of this were more local. What are the needs of people who are making choices that are leading them to being in dire circumstances? It might be behavioral and lifestyle choices; it might be financial management choices; it could be self-care choices that lead them to circumstances where their life is not as secure as it might be. Their difficult circumstances are a ramification of lifestyle and self-satisfaction choices they have made.

I am connected to a place right now that serves the LGBTQ community and the HIV population. Some Christians find it easy to be very judgmental of this population and not share their compassion in this direction. Rather, they choose to share their compassion in other circumstances where the reasons and the choices are less known. Is this what Christ calls us to do? Are we called to show compassion or walk away?

Consider the story of the woman caught in adultery in Luke Chapter 8.

Luke 8:1-11 MSG

 Jesus went across to Mount Olives, but he was soon back in the Temple again. Swarms of people came to him. He sat down and taught them.

The religion scholars and Pharisees led in a woman who had been caught in an act of adultery. They stood her in plain sight of everyone and said, “Teacher, this woman was caught red-handed in the act of adultery. Moses, in the Law, gives orders to stone such persons. What do you say?” They were trying to trap him into saying something incriminating so they could bring charges against him.

Jesus bent down and wrote with his finger in the dirt. They kept at him, badgering him. He straightened up and said, “The sinless one among you, go first: Throw the stone.” Bending down again, he wrote some more in the dirt.

Hearing that, they walked away, one after another, beginning with the oldest. The woman was left alone. Jesus stood up and spoke to her. “Woman, where are they? Does no one condemn you?”

“No one, Master.”

“Neither do I,” said Jesus. “Go on your way. From now on, don’t sin.”

Her choices were well known, and she was being very degraded. She was called before the council having been caught in the act.   The council members were ready to stone her. Jesus said those without sin could cast the first stone. We are so quick to categorize sins, but it doesn’t seem Jesus categorizes sins. What are we called to do as Christians? I am struggling with this and I’m challenging others to struggle with this, too. This is not a blog with answers. It is a blog with challenging questions. I would love to hear what people think.

Luke 6:37 ESV

“Judge not, and you will not be judged; condemn not, and you will not be condemned; forgive, and you will be forgiven;

It has become clear to me as a practitioner that sex as defined in the Bible, as designed by God does not lead to trauma, whether emotional or physical, and it does not lead to disease transmission or to promiscuity.

But in society, especially in the current waive of rules avoidance and focus on self, sex is being used in a lot of other ways. When used outside the way described by God, it does lead to a lot of issues. We create our own problems when we are outside this definition.

Another example heavy on my mind is substance abuse. The numbers of people caught in addiction and dying of overdose are astounding. This is a tragedy of great proportion! Yet the local rescue mission is struggling to stay funded. People who have been caught up in abuse and addiction who are now reaching out for help to leave that lifestyle are encountering limited spots available for rehabilitation. Yet Christians are looking for meaningful outreach and missions opportunities.

I am in full support of refugee aid, international response to crisis, local response to crisis, support of children in underserved areas, teens on mission trips, college students on mission trips, medical missions, and so much more. In addition to all of this wonderful outreach, I encourage us to search our hearts and God’s leading for our attitudes about reaching those in circumstances in our own community that are harming them.

I propose when we limit our compassion or draw a line for how we will consider using our resources, it is similar to an incomplete medication review.  Completeness and effectiveness are limited.

James 4:12 ESV

There is only one lawgiver and judge, he who is able to save and to destroy. But who are you to judge your neighbor?

What is your response?

Blessings,

Michelle

 

 

 

 

Are Your Medicines Improving Your Quality of Life?

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Quality of life should be preserved and enhanced with your medication.

Medications have two main purposes.

  • One is to increase your QUALITY of life. They relieve or control the symptoms that make it hard to do our daily tasks. Quality of life is your ability to enjoy and engage in your life. It is your ability to do the things you want to do during the day.
  • The other is to increase your QUANTITY of life. They help control medical conditions so you can live longer.

ALL medications have potential side effects. Some of these side effects are a minor nuisance that goes away. Some of these side effects are so severe you are changed to a different medicine. Then there are some times when another medicine is started to treat the side effects of the first medicine. In most situations I highly discourage this practice. There are a few select exceptions.

Medications and Quality of Life

This blog is about the medications that are prescribed to help you live better. Using them is intended to improve your quality of life. But, they have side effects that keep you from functioning normally. Those side effects actually decrease your quality of life. Here are a few examples:

  • Pain medication for back pain makes you so sleepy you just lay around.
  • Blood pressure medicine makes your blood pressure so low you don’t have the energy to do regular daily tasks or you get really dizzy when you stand up or turn quickly.
  • Anxiety medicine keeps you so groggy you can’t function.
  • Sleep medicine keeps you sleepy all through the next morning.
  • Diabetes medicine makes your blood sugar so low you are weak, shaky, and dizzy.
  • Parkinson’s Disease medicine makes you so dizzy you can’t go out.
  • Incontinence medicines makes you so constipated you are miserable.

It doesn’t make sense for a medicine intended to help to actually cause just as many problems as the thing it was prescribed to treat. Talk to you doctor! Your doctor might not know unless you talk about it. Your relationship with your doctor should include conversations about your goals. Let your doctor know what daily events and tasks are important to you. Then, work together to reach those goals through medication, physical therapy, counseling, diet, or other means.

We are here to help, too! At Meds MASH we will carefully review all of your medicines to be sure you are getting the maximum benefit with the least side effects. Often a dose change or an alternate medication can make a huge difference. We work closely with your doctor to optimize your medicines. You don’t need to live with side effects that hold you down. Contact us at www.medsmash.com.

BIBLICAL APPLICATION

What is your purpose for being? I had a chance to ‘people watch’ for a while this week. It got me thinking about what drives people. We know that EVERYONE has insecurities. Everyone has struggles. God has a purpose for everyone. Society gives a lot of messages that don’t align with the Bible. A lot of people have never even heard about the God who loves them. People have so many reasons for the actions they take. As a whole, people are so confused.

Here are a few reasons for decisions that come to mind:

  • Some people elevate themselves by suppressing others.
  • Others spend all of their time growing their sphere of influence.
  • Some live to serve and please others (sometimes at risk to themselves).
  • Several spend their time protecting themselves.
  • And then some hide from other people and insulate themselves.

Our selfish actions can have unwanted side effects, just like the medications discussed above.

Are we to spend this life racking up points? No! That is exactly why Christ died and rose. He took the ‘rules’ and replaced them with grace and redemption. You don’t have to ‘earn’ your way to Him.

John 3:16-18 The Message

“This is how much God loved the world: He gave his Son, his one and only Son. And this is why: so that no one need be destroyed; by believing in him, anyone can have a whole and lasting life. God didn’t go to all the trouble of sending his Son merely to point an accusing finger, telling the world how bad it was. He came to help, to put the world right again. Anyone who trusts in him is acquitted; anyone who refuses to trust him has long since been under the death sentence without knowing it. And why? Because of that person’s failure to believe in the one-of-a-kind Son of God when introduced to him.

I’m hoping this makes you rethink your purpose for being the way it makes me rethink mine. As I make decisions each and every day, what is my underlying motivation?

I am called to believe, trust, and follow in faith. If I am walking closely with God, He will help me make decisions that make sense. He has this perspective that is so far beyond anything I could imagine.

Proverbs 3:5-6 ESV

Trust in the Lord with all your heart, and do not lean on your own understanding. In all your ways acknowledge him, and he will make straight your paths.

James 1:5 ESV

If any of you lacks wisdom, let him ask God, who gives generously to all without reproach, and it will be given him.

So contrary to what society tells you and where your own flawed thinking might take you, your priority can be God’s plan for you. Staying focused on this can help you avoid decisions that hurt other people. It can help you take the focus off of yourself. It won’t rid you of problems, but it can increase your confidence that you’re not alone.

Just say ‘no’ to the side effects of selfish thinking!

Blessings,

Michelle