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Discuss medication complications with patients

Ambulatory Safety Monitor, April 14, 2004

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Tracking patients' progress is tricky in an ambulatory setting because they are not monitored on a continual basis like hospitalized patients. Patients might develop complications from a medication, but the primary care physician (PCP) isn't always informed.

There are several reasons why ambulatory physicians might not have all the necessary information to properly treat patients. Sometimes patients fail to report complications or problems, and often elderly patients see more than one physician and might not share all relevant information with each one, said Tejal Gandhi, MD, MPH, director of patient safety at Brigham and Women's Hospital in Boston. Gandhi spoke during a February 12 Massachusetts Medical Society conference about improving patient safety in the ambulatory setting.

Medication errors are relatively common in ambulatory settings, according to results from a 2001 healthcare survey in Massachusetts. More than one-fifth of ambulatory patients polled said they or a family member had experienced an adverse event because of a prescription. Another patient survey of 11 Boston ambulatory clinics found that 18% of patients thought they had a drug complication, although only 3% reported them to their PCPs, said Gandhi.

To reduce medication errors and improve patient safety, physicians need to teach patients the importance of speaking up, said Gandhi. This means physicians should make patients understand

* any possible side effects
* the need to take the medication exactly as prescribed
* the need to tell the physician if they develop any side effects
* what they need to do if they develop specific side effects
* that they can ask the doctor to change a medication if it doesn't seem  to be helping

Physicians should try to develop a partnership with patients, said Gandhi. For example, physicians can explain why they are prescribing certain medications and then ask patients whether they have any questions.

TIP: Don't assume that other physicians have shared information about various drugs. Ask patients whether they know why they take various medications.

Some physicians create Web sites that allow patients to review their medication lists and check for possible side effects or interactions, said Gandhi.

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