Performing that initial assessment
Performing that initial assessment
Know your patients’ drugs, lifestyle
When an agency first takes on a patient, it must conduct a thorough medication assessment to learn about the patient’s inventory of medications, drug-taking habits, and any obstacles to proper medication management.
Some facets of a good assessment:
• Details, details, details. Start with a comprehensive list of all the drugs a patient is taking. Include the dosages, medication schedule, prescribing physicians, and the symptom or ailment for which each drug is being taken.
• Are all of the drugs clearly labeled? Does the dosage ordered by the physician match the instructions on the bottle? What is the stop date for each drug? Ask the patient to bring out all the pills that he or she has in the house, including leftover drugs from previous prescriptions.
• Self-prescribed medication. Ask to see all over-the-counter medication, vitamins, and herbal remedies the patient is taking. Note how often those drugs are being taken and why. Don’t forget herbal teas and tinctures, which the patient may not consider as drugs.
• Lifestyle issues. Does the patient smoke? Drink alcohol? Drink coffee or sodas containing caffeine? All can interact with medications.
• Drug-taking schedule. Ask the patient to describe in detail the routine used in taking medication. Where are the drugs stored? Are they kept in the original containers or put in other pill boxes?
• When does the patient take each drug? Often, patients don’t take doses strictly by the clock, but by landmarks in their day, such as during breakfast, or after an afternoon nap. Compare the schedule described by the patient with the prescribed schedule.
• Side effects, interactions. Nurses should ask about any symptoms patients may be experiencing. Ask about specific symptoms related to the drugs being taken, but also generally about any physical changes since the medication began.
• Patient attitudes. Does the patient believe the medication meets his or her health care needs? Does the patient feel that the medicine is unnecessary, or express an unrealistic expectation about the medication?
• Who is in charge of the medication? Is it the patient? A particular caregiver? This is particularly important when a patient has multiple informal caregivers.
• Good medication management practices. Does the patient use the same pharmacy for all prescriptions? Do different physicians know what each other are prescribing? Does the patient have a list showing all the drugs being taken that can be shown to each physician?
• Learning ability. Does the patient speak and understand English? Can he or she read? Would the patient be better served by drug information that relies more on pictures? Thorough investigation at the earliest assessment will make it easier to monitor and manage the patient's medication throughout the length of their care. And continued revision of the assessment will keep their records current.
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