What is the rationale for conducting a medication review?

The Rationale for Conducting Medication Reviews

Medication reviews are essential for reducing preventable medication-related harm, decreasing hospital readmissions by 8% overall and up to 15% with multiple patient contacts, and potentially reducing mortality by 19% when properly conducted. 1

Core Purposes of Medication Reviews

Medication reviews serve several critical functions in patient care:

1. Patient Safety Enhancement

• Identifies and resolves medication discrepancies that could lead to adverse events
• Detects potentially inappropriate medications (PIMs) and polypharmacy issues
• Prevents medication-related problems that can lead to hospitalization or mortality 1

2. Medication List Accuracy

• Creates a Best Possible Medication History (BPMH) by verifying what medications patients are actually taking
• Reconciles discrepancies between prescribed medications and what patients report taking
• Ensures documentation of allergies and adverse medication reactions 1

3. Clinical Outcomes Improvement

• Reduces hospital readmissions (8% overall reduction, 15% reduction with ≥2 patient contacts) 1
• May reduce all-cause mortality (19% reduction in studies with comprehensive mortality assessment) 1
• Improves medication appropriateness and reduces medication-related problems 2

Structured Approach to Medication Reviews

The medication review process should follow these key steps:

Step 1: Verification

• Review patient's medication history using at least two sources of information
• Interview patient/caregiver using open-ended questions
• Document allergies and vaccination history
• Address adherence issues
• Include often-omitted medications (OTCs, herbals, supplements, non-oral medications) 1

Step 2: Clarification

• Identify discrepancies between what is prescribed and what patient is taking
• Present discrepancies to appropriate healthcare providers who can make necessary changes
• Evaluate each medication for:
  • Continued need for the medication
  • Appropriate dosing and administration
  • Potential drug-drug interactions
  • Potential drug-disease interactions
  • Current or potential adverse effects 1, 3

Step 3: Documentation

• Document changes made to medication list in a centralized location
• Maintain accurate records of medication changes and problems
• Document any unresolved discrepancies with plan of action
• Record date and person who performed the medication review 1

Step 4: Communication

• Share updated medication list with patient and relevant healthcare providers
• Educate patient about their medication regimen
• Ensure all healthcare providers have access to the most current medication information 1

Key Elements for Effective Medication Reviews

Research indicates that medication reviews are most effective when they include:

1. Multiple patient contacts (≥2 contacts shows twice the effectiveness in reducing readmissions) 1
2. Pharmacist involvement in the review process 2
3. Comprehensive mortality assessment for accurate outcome measurement 1
4. Targeting high-risk populations, particularly older adults with polypharmacy 1
5. Team-based approach with clearly defined roles and responsibilities 1

Common Pitfalls and How to Avoid Them

Incomplete Medication Lists

• Use multiple sources of information (not just patient report)
• Implement "brown bag" reviews where patients bring all medications
• Use telephone or secure messaging reminders to improve patient participation 1

Inadequate Follow-up

• Schedule multiple patient contacts (at least 2) to maximize effectiveness 1
• Create action plans for unresolved discrepancies 1

Poor Communication Between Providers

• Maintain one centrally located medication list accessible to all providers
• Share updated medication lists with all relevant healthcare providers
• Document who performed the review and when 1

Superficial Reviews

• Conduct thorough evaluations of each medication rather than simply verifying the list
• Discuss multiple medication management topics for each medication (efficacy, directions, etc.) 4

By implementing structured medication reviews with these key elements, healthcare providers can significantly improve patient safety, reduce hospital readmissions, and potentially decrease mortality while optimizing medication therapy.