Personalized medication communication is key to preventing patient harm during care transitions
Older patients are likely to have complex medication regimens, which must be carefully managed as they move between and within multiple settings, including primary care, acute care, geriatric rehabilitation, and nursing facilities. care facilities for the elderly. These moves often involve different health professionals, such as general practitioners and medical specialists. Problems with medication communication across transitions of care are key reasons for the increased risk of medication-related problems and hospital readmissions.1,2,3.
Discussions with older patients and families are often not prioritized in transitions of care; instead, fleeting conversations take place at irregular times and for short periods just before or after transfers.4 These conversations are rarely organized in a goal-directed manner where medication communication is conveyed accurately, clear and complete. The impact of fleeting conversations is that even if information about medications is conveyed, patients and families may not be involved in key decisions about medications that have been recently prescribed, discontinued, or discontinued. they have changed, or they may not express their concerns and preferences about the medication regimen.5 There is a lack. of recognition that “the only person who remains constant is the patient, who has the most to lose in a disconnected healthcare system”.6
Patients and families are excluded from conversations about medication management in transitions of care
Communication for shared medication decision-making across care transitions is largely disorganized and haphazard.7,8 Shared medication decision-making involves health professionals, older patients, and families communicating together to define the medication problem, outline the options available, check for understanding, elicit the patient and family. values, support patient and family deliberation, and reach mutual agreement.9 Currently, elderly patients and families must show great fortitude and perseverance to express their vision.7,8 For many professionals of health, drug communication includes the delivery and receipt of information. activities,10 where they do not ask about older patients’ experiences, beliefs, and attitudes about medication.7,8 Eliciting patient and family priorities and preferences in medication decision-making is often perceived as a challenge. , impractical and time-consuming.7,8 However, if communication with medicines is to facilitate To make shared decisions, it is necessary to move from consultations to give and receive information to interactive, personalized and deliberate conversations along the continuum of the ‘attention.11 Even if not all patients and families want to participate, creating opportunities will help reduce fear and anxiety and support those who are unwilling or unable to participate.
Many factors contribute to the ability of healthcare professionals to facilitate engagement with older patients and families.5 Older patients with complicated medication regimens, those with mental health problems, those from lower socioeconomic backgrounds or low levels of literacy, and Aboriginal and Torres Strait Islander people and migrants. populations are particularly at risk.6 Older patients may want to avoid responsibility for fear of making inappropriate decisions, or they may believe they lack the capacity to participate due to language, cultural, cognitive, and disease-related barriers.8
Related to medication decision-making is the ethical and legal requirement to obtain informed consent before prescribing medication.12 If the elderly patient lacks decision-making capacity, a surrogate, such as a family member, should to make the decision. They have the right to refuse prescribed medication, even if this view is contrary to medical recommendations. In the same way, they can change their mind and withdraw consent about the prescribed medication at any time. 12
Our aspiration should be a consistent practice of medication engagement with older patients and families
Medication engagement should occur during care transitions and replace fleeting conversations, using resources to help older patients and families communicate effectively.13,14 The Elderly Advocacy Network Older People (OPAN) has a set of materials, including video recordings in several languages, to support older patients and families in making decisions about medicines. .15,16 The following principles can help cultivate medication communication that goes beyond casual conversations.7,8.
- Communication about medication should occur throughout the care of older patients rather than being limited to specific times.
- Families should be included in medication communication at every opportunity, in ward rounds, family meetings, bedside discussions and GP discussions, rather than waiting until medication advice occurs just before hospital discharge or just before completing a primary care consultation. Families should be informed of when these discussions will take place so they can plan to be available.
- Communication should be tailored to each patient’s comprehension ability using clear and easy-to-understand language, using resources including diagrams, medication photographs, audio and video recorded materials, simulations and patient case scenarios .
- Doctors, nurses, pharmacists, and other health care professionals need to recognize that they all have an important role to play in communicating with each other about medication during care transitions.
- Healthcare professionals should regularly seek patient and family priorities and preferences, especially if changes in medication are made. Older patients and families should be encouraged to ask questions about the drugs they are prescribed: what drugs and non-drug options are available, what are the benefits and potential harms, what are the costs involved, how should they be taken the medicines and for how long.16
- Shared decision-making is supported by communication with patients and their families about the current medications they are taking, the consequences of not taking them, when they are reviewed to decide whether to continue them, and who perform the review. This deliberation allows older patients and families to have their say on whether or not they agree with these decisions. Their understanding can be checked by asking them to repeat in their own words what has been communicated to them.
- When facilitating informed consent to prescribe medication, decision aids can be helpful. Its use should be documented in medical records for future retrieval.
conclusion
Fostering engagement between older patients and families and creating opportunities for decision-making about medications are crucial to improving safety and quality in care transitions. Challenging fleeting conversations is key to reducing the risk of medication-related problems and patient harm.