| a structured evaluation of a patient‘s medicines with the aim of optimizing medicines use and improving health outcomes. This entails detecting drug related problems and recommending interventions
A structured, critical examination of a patient’s medicines with the objective of reaching an agreement with the patient about treatment, optimising the impact of medicines, minimizing the number of medication-related problems and reducing waste.’ | Medication Review |
| Principles of Medication Review | 1. All patients should have a CHANCE TO RAISE QUESTIONS and highlight problems about their medicines.
2. Medication review SEEKS TO IMPROVE OR OPTIMIZE impact of TREATMENT for a patient
3. The review is undertaken in a SYSTEMATIC WAY, by a competent person
4. Any CHANGES resulting from the review are AGREED WITH THE PATIENT
5. The review is DOCUMENTED in the patient’s notes
6. The impact of any change is MONITORED |
| provides the opportunity to discuss the patient’s values and beliefs, and how taking medicine fits in with the patient’s daily life. It provides an opportunity to assess patient’s knowledge of their medication. | Face-to-face review |
| Type of Medication review | Type 1: Prescription Review
Type 2: Concordance and Compliance Review
Type 3: Clinical Medication Review
PCC |
| Review Process | 1. Identify patients
2. Carry out the review
3. Record review outcomes / Feedback results
4. Audit / Quality assurance
ICRA |
| Medication review may initially need to be prioritized to patients who are __ | at risk of medicine related problems. |
| (Carrying out the review)
Ten-point medication review | 1 Why is this patient taking this drug?
2 Is the reason clear from the history summary?
3 Is the patient capable of taking this drug and is compliance satisfactory?
4 Are any tests required to monitor side-effects or dosage?
5 Are there any potential drug interactions and are they of significance?
6 What would happen if the drug was stopped?
7) Does the repeat need to be continued for the next 6 or 12 months?
8)Are any non-repeat items being prescribed regularly?
9 Should these be converted to formal repeats?
10 Set a date for the next review? |
| Recording the review outcomes | Level 1: REVIEW OF A LIST OF THE MEDICATION under the direction of doctor, nurse or pharmacist, but in the ABSENCE OF THE PATIENT
Level 2: TREATMENT REVIEW UNDER THE direction of a doctor, nurse or pharmacist, in the ABSENCE OF THE PATIENT but with REFERENCE to the CODING ONLY PATIENT’S CLINICAL RECORD
Level 3: CLINICAL MEDICATION REVIEW specifically undertaken by a doctor, nurse or pharmacist in the PRESENCE OF THE PATIENT with ACCESS to the PATIENT’S CLINICAL RECORD and LABORATORY TEST RESULTS as required |
| One method of assessing the quality of the review system is by evaluating the feedback from patients or their carers who have participated in the medication review process. This might include an evaluation of their experience of the review and the level of satisfaction with its outcome. | Quality Assurance |
| Medication review is an integral part of the repeat prescribing process and many practices undertake regular __of their repeat prescribing system.
Implementing changes
Documentation
Communication of changes
Follow up | Audit |
| Who does the Review? | In practice doctors, pharmacists and many nurses have the clinical skills and therapeutic knowledge to perform all aspects of medication review |
| (What should the review cover? )
For each drug: Check that: | 1 The medication prescribed is APPROPRIATE for the patient’s needs
2 The medication is EFFECTIVE for the patient
3 The medication is a COST EFFECTIVE choice
4 Any required MONITORING has been done or arrangements are in place |
| The NO TEARS Mnemonic to Aid Medication Review in a 10 Minute Consultation 10 | N Need and Indication
O Open Questions
T Tests and Monitoring
E Evidence and Guidelines
A Adverse Events
R Risk reduction or prevention
S Simplification and switches |
