Psychiatrists who treat older patients should review their patients’ medications very carefully, particularly when they are seeing a patient for the first time after a referral from a hospital, speakers at the American Association for Geriatric Psychiatry (AAGP) 2023 Annual Meeting in New Orleans said yesterday.
“More than 60% of medication reconciliation errors occur during transitions of care, usually on hospital admission, but then they perpetuate down the line” with each transition, such as from general hospital to psychiatric hospital, or upon discharge to home or another facility, said Paula Lester, M.D., in a presentation titled “Medication Reconciliation: Paperwork Saves Lives.” She is an associate professor of medicine at New York University (NYU) Long Island School of Medicine. “This is even more true for psychiatric patients, especially geriatric psychiatric patients because they have more frequent and longer admissions, and they have more care transitions.”
Lester added that older patients with mental illness often end up being transferred from a general hospital to a psychiatric hospital or vice versa, and that the electronic health record systems may not integrate well with one another. Furthermore, hospitalists in other specialties may be unaware of possible interactions between psychiatric medications and the medications they prescribe, she added.
Mark Shen, Pharm.D., a clinical pharmacist in care transitions at NYU Langone Hospital–Long Island, advised that psychiatrists try to use two sources of information when taking a complete medication history, such as the patient, caregiver, other physicians involved in the patient’s care, or the discharging hospital.
“One source might not be fully correct, and the other source might not be fully correct. It’s up to you to match those two lists together and come up with a list that makes sense,” Shen said.
Shen also suggested asking open-ended questions when speaking with patients, such as the following:
- What medications, including prescription, over the counter, and supplements, do you take?
- What medications do you take each day?
- What medications do you take only sometimes? For what symptoms do you take these medications?
- What medications do you take that are not pills (for example, eye drops, creams, patches, long-acting injectables)?
- What time do you take the medications
- Do you have any issues with unintended effects?
If patients do not take a medication as prescribed, psychiatrists should ask them why, Lester said.
“Sometimes there are good reasons why, [such as] side effects or they’ve taken it before and had a bad experience so they’re afraid of taking it again,” Lester said.
For related information, see the Psychiatric News article “To Improve Safety in Older Patients, Consider Deprescribing.”
(Image: iStock/gorodenkoff)
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