Elizabeth Meichsner, MD
Elizabeth Meichsner, MD, family medicine resident, University of Minnesota Family Medicine Residency Program, Methodist Hospital, St. Louis.
After your stay at a hospital is over, there’s something that you should do before you step out the door.
Talk to the hospital pharmacist—especially if you were taking multiple medications before you got to the hospital and/or you just got a few new drugs from a doctor to add to your routine.
Why is it so important to have the chat at that moment?
About 63% of medication errors in the US are due to a communication breakdown—which is particularly common at a point of transition, such as when a patient leaves the hospital—according to The Joint Commission, a nonprofit that accredits health-care organizations in the US.
A clinic in Minnesota recently conducted a study to find out whether bridging that particular communication gap might be helpful to patients.
And I know you’ll be interested to find out what they discovered…
Researchers gathered hospital patients who each had at least one chronic medical condition…were currently taking at least five medications…and/or were expected to receive at least three new medications at the time of discharge. Just before each patient left the hospital, he or she had a consultation with a hospital pharmacist that lasted, on average, 20 minutes.
During the consultation between the pharmacist and the patient, the pharmacist talked with the patient about how he or she was taking each medication (such as whether he was taking the drug at a certain time of day…with a beverage and/or a meal, etc.) and asked the patient whether he had been experiencing any drug side effects. The goal was for the pharmacist to help the patient optimize dosing (so the drug is most effective)…minimize or eliminate side effects…and/or see whether the patient could stop taking certain medications. The patient was encouraged to ask the pharmacist questions and make sure that he understood the reason for taking each drug.
Researchers wanted to see whether patients found this conversation to be valuable. They also were curious to find out whether there were any recommended medication changes as a result of the consultations.
What they found: Patients felt more at ease as a result of the consults, which wasn’t surprising. But here’s the real stunner—nearly three-quarters of the consults resulted in the pharmacists and doctors coming together to recommend medication changes that were related to the reasons that the patients came to the hospital.
And these weren’t just minor recommendations, according to Elizabeth Meichsner, MD, a study coauthor. Most recommendations pertained to major, often life-saving medications, such as cardiovascular drugs, antidepressants and pulmonary drugs. The recommended changes ran the gamut—sometimes patients were told to take a drug differently…sometimes they were told to take an additional drug or take fewer drugs…and sometimes they were told to switch drugs. In other words, most patients received advice as a result of the consult that they wouldn’t have otherwise received.
Now, the researchers didn’t study what percentage of patients implemented the recommended changes…nor did they analyze whether the recommended changes turned out to be helpful or harmful…nor did they examine whether these consults resulted in lower hospital readmission rates. Hopefully future studies will address those issues. Still, the impact of these consults is impressive.
It’s important to note that these consults were arranged by the hospital specifically for this study—so all the pharmacists and doctors were aware of the process and on board. Unfortunately, this isn’t currently a regular practice at this particular hospital, nor is it a regular practice at many hospitals in the US. But a program is now being developed at Dr. Meichsner’s hospital, based on these findings, so it will soon become regular practice there. This is a relatively new concept, said Dr. Meichsner, and if this proves to reduce medication-related problems and/or save money, the hope is that more hospitals will follow suit.
But that doesn’t mean that you can’t be proactive and arrange this sort of consult yourself before you leave a hospital. Even if you have confidence in your doctors, it can potentially help, so why not try it? Maybe one simple recommendation from a pharmacist would help your drugs work more effectively…reduce or eliminate side effects…or help you get off a drug you’re taking. To me, that’s certainly worth 20 minutes!