Good communication in healthcare is perhaps most important when it comes to messages around medication management, with miscommunication and breakdowns in conveying information having potentially serious consequences for the patient.
The authors of an article recently published in the Medical Journal of Australia’s Perspectives series support this notion, revealing that when it comes to medication management of older people, clear communication is even more important.
With older people often having complicated medication schedules, the researchers say communication breakdowns between the healthcare services they require may put them at risk of medication-related problems and hospitalisation.
Medication miscommunication, they add, may lead to patients not being fully informed about their medications or having the opportunity to ask required questions.
They say conversations about medications are needed more frequently, with more family involvement, while communication around medication also needs to be better tailored to what the individual patient needs to understand and remember.
Lead author Professor Elizabeth Manias, from the Centre for Quality and Patient Safety Research at Deakin University, and her colleagues say older patients are likely to have complex medication regimens that need to be carefully managed as they move across and within diverse settings, “including primary care, acute care, geriatric rehabilitation, and aged care facilities” and involving different health professionals across specialties.
“Discussions with older patients and families are often not prioritised across transitions of care. Instead, fleeting conversations take place at irregular time points and for short periods just before or after transfers,” Professor Manias and colleagues wrote.
“These conversations are rarely organised in a goal-directed way where medication communication is conveyed accurately, clearly, and comprehensively.
“The impact of fleeting conversations is that even if medication information is conveyed, patients and families may not be involved in key decisions about newly prescribed, ceased or changed medications, or may not voice their concerns and preferences about the medication regimen.
“There is a lack of recognition that ‘the one person who remains constant is the patient, who has the most to lose in a disconnected health system’.”
How to ensure clear communication
Professor Manias and colleagues recommend the following principles:
- Communication about medication should occur throughout the duration of older patients’ care, rather than being limited to particular time points.
- Families should be included in medication communication at every opportunity, rather than waiting until medication counselling occurs just before hospital discharge or just before completing a primary care consultation.
- Communication needs to be tailored to each patient’s ability to comprehend, with clear, easy-to-understand language, using resources including diagrams, photographs of medications, audio and video recorded materials, simulations and patient case scenarios.
- Doctors, nurses, pharmacists and other health professionals need to acknowledge they all have important roles in communicating with each other about medication across transitions of care.
- Health professionals need to regularly seek outpatient and family priorities and preferences, especially if medication changes are made. Older patients and families should be encouraged to ask questions.
- Shared decision-making should be supported by communicating with patients and their families about the current medications they take, the consequences that may occur if medications are not consumed, the time when these are reviewed to decide if they will be continued, and the person who conducts the review.
- In facilitating informed consent to prescribing medications, decision aids can be helpful. Their use should be documented in medical records for future retrieval.
“Fostering engagement among older patients and families and creating opportunities for decision making about medications are crucial for improved safety and quality across transitions of care,” Professor Manias and colleagues wrote.
“Challenging fleeting conversations is key to reducing the risk of medication-related problems and patient harm.”
For more information, visit: doi.org/10.5694/mja2.51651
This feature was originally published in the September issue of Retail Pharmacy magazine.
