Saturday, March 07, 2009

Your Medications and Health History

Do you know the names of all of your medications, the exact dosages, and why you are taking each one? I know from experience in interviewing thousands of patients, that it can be difficult to recall this information offhand.

Knowing the details of a patient's health history and their medications (including over-the-counter herbal and non-prescribed medications) is vitally important. Harmful errors have occurred in health care because of oversights and lapses in communication, particularly in regard to medications. Health providers rely on the patient or their family members to provide current and complete information when they present for treatment. That doesn't always work very well for a variety of reasons.

A better way . . . ?

Electronic technology is undeniably amusing and entertaining, but it's particularly satisfying when it's used for helpful and practical purposes. For years there's been talk about creating electronic medical records to seamlessly connect health care providers with their patient's health and medication histories. A number of computer software health history programs exist that offer hospitals and physicians the capability of internally tracking patient data.

A truly electronic medical history that would share relevant health information in order to synchronize care may eventually be a reality. Over the past few years hospitals have been struggling to meet an important patient safety goal established by the nation's hospital accrediting agency, the Joint Commission. "Medicine reconciliation" is a process that requires the patient's current medications to be completely documented and carefully reviewed every time they are admitted, discharged, or transferred. The physician responsible for their care must specifically note whether or not each individual home medication is to be continued at every step. This process requires more time and more consideration--that's a good thing. However, it's also tedious and takes away from direct patient care (from the nursing standpoint), and I think we can all agree that's NOT a good thing.

Lately I discovered ihealthrecord, and I have a great deal of enthusiasm for this virtual medical record. The American Medical Association and six other leading, reputable medical organizations launched a company called Medem which created the ihealthrecord about 8 years ago. Ihealthrecord is a free way to record your history and medication list on a secure website. You can access, add or change the information with your password via the internet anytime you want and print a variety of reports, including a wallet medication card. You can choose to give your personal physician "read only" access to the information you've posted online, or simply provide them with copies of the reports you print.

I recently spent about 30 minutes registering and completing an online ihealthrecord (granted I don't take a lot of meds, so it could be more time consuming for those who do . . .), and I wholeheartedly recommend this as a great tool for organization and communication of medical history. It would be wonderful to have a product like this as a national standard to synchronize an individual's health care.

Remember to include this information . . .
when you are making a med list (along with dosages, concentrations, and frequency as appropriate):
  • Topical patches (for pain or smoking cessation, etc.)
  • Include the whole name of the medication--if there is an "XL" or "CR" at the end of the drug name--it is important to include that
  • Implanted medication delivery devices (like baclofen pumps)
  • Inhalers and meds given via nebulizers. Include the dosages--read the labels to find out. Advair, for example is a common inhaler, but it comes it two different dosages 250/50 and 500/50.
  • Eye drops
  • Creams or ointments for skin conditions
  • Medications taken only "as needed," for example--sleeping pills, pain or allergy meds.
  • Equipment for which a doctor's order is required (bladder catheters, colostomy supplies, insulin syringes, specific wound-care supplies, etc.)
  • If you use CPAP or BiPAP devices include your usual settings.
  • For insulin pump users--record your pump settings.
  • Record special medications that are given periodically (like IV infusions for osteoporosis or other medical conditions or periodic injections of vitamins, etc.)
  • Emergency medications you require, such as an Epi pen, glucagon, etc.
  • Information about contraceptives, including the name & dosage of pills or date of the last injection if using Depo Provra.
  • Vitamins, herbs, any other supplements
  • Include the name and phone number of your pharmacy on your medication list.

Regarding health history:

  • include information about pacemakers and implanted defibrillators (you should have been given a wallet card with the information)
  • provide details about implanted IV ports (infusaport or portacath), dialysis grafts or catheters, and anything else that is "unseen" but important for your health provider to know about.

. . .

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