I found the process of completing a medication reconciliation to be extremely interesting, especially since it was on a close family member. It felt like a deep dive into an often very personal aspect of someone’s life, and I was grateful that my relative was willing to be so open and answer my many questions. During this process, I noted multiple safety concerns for my patient relating to polypharmacy, drug interactions, adverse reactions of particular relevance to this patient, and, perhaps most importantly, the sheer number of medications the client must remember each day. I think it would be interesting to speak with the patient’s doctors to go over his medication regimen. I would be fascinated to learn the process that physicians go through to make decisions about prescribing drugs, especially in the case of polypharmacy when so many drug-to-drug interactions must be considered. If the patient experiences adverse reactions common to more than one medication they are taking, how does the doctor determine the root cause and adjust accordingly?
Upon my questioning, the patient verbalized a mostly correct but very basic understanding of his medications. It was clear that he had received education from healthcare providers, but his knowledge did not extend beyond the surface level. I don’t think that patients necessarily need to be “experts” on every medication they take (I have certainly taken medications without much understanding of what they are for, simply relying on the “doctor’s orders”), but a basic knowledge of the medication’s goal, why they take it, and adverse effects and signs of complications should be standard. This patient often stated that he took certain medications “for my diabetes,” or “for my feet.” It would be preferable if he could verbalize what the goal of the medication was (for example, “it helps lower my blood sugar when it gets too high,”) and why it was necessary for him (for example, “I have type II diabetes which can cause my blood sugar can get too high. This can be dangerous.”) It is also important for patients to understand why they are on each medication because they can report to their providers if the targeted condition is worsening or improving. Without understanding what the medication is for, the patient or providers will struggle to determine if it is doing what it should.
The client was on multiple medications to control his diabetes. Upon my questioning, he could not tell me why he took so many drugs to treat the same condition. When I researched one of these medications, empagliflozin, I learned that, when combined with other anti-diabetic meds, it can increase the patient’s risk of developing hypoglycemia. Additionally, the patient was not fully aware of the potential major side effects or interactions of his medications. I did my research after speaking to the patient about his medications, thus, I did not learn about these adverse effects and interactions, such as metFORMIN contributing to lactic acidosis in patients with heart failure, until after I’d met with him. I certainly don’t want to go back and act like a know-it-all student nurse, lecturing him about all these findings, but I will encourage him to speak to his doctor and ask questions, especially given that he has upcoming appointments with a cardiologist and pulmonologist. As a whole, I found this project provided much insight into the role of the nurse in educating patients about their medications, as well as providing a second pair of eyes for prescriptions, detecting safety risks that may have been overlooked. Nurses play a large role in medication safety, and, with today’s aging population and increased prevalence of polypharmacy, this role is only further emphasized.
