The Importance of Medication Reconciliation in the Dental Practice

Donald Wood, CRNA, CPHRM, Patient Safety Risk Manager II

Medication reconciliation, the process of creating the most accurate list possible of all the medications a patient is taking, should be accomplished with each patient visit. The substantial number of medications available today and the variety of indications for their use can make the process very challenging before prescribing or administering any medications necessary for dental treatment. There are two important tasks for successful medication reconciliation outcomes. Determine the medication currently taken by the patient, and ask the patient if he or she has any allergies to medication, food, or other substances.

A 2016 study by the Centers for Disease Control and Prevention (CDC) estimated that 47 percent of people used at least one prescription medication within the previous 30 days while over 10 percent were on five or more prescription medications. In the age group of 65 years and over, 90 percent of people had taken a prescription medication in the previous 30 days while 40 percent had taken five or more prescription medications in the same timeframe.1

Always ask the patient to provide a list of his or her medications, but keep in mind that the actual number of medications used by the patient may be higher than what is listed. You may also want to consider reconciling a patient’s medication with a technique known as the “brown bag method.” Ask the patient to bring all medications that he or she takes to the next office visit, including any nonprescription or over-the-counter medications. The medications should also include any herbal medications and nutritional supplements.

If the purpose of the medication is not labeled on the container, ask the patient to explain why he or she is using the medicine. Many drugs that have been on the market for a long time are being used to treat illnesses for which they were not originally intended. For example, propranolol was originally marketed in the United States in 1965 as a beta blocker for the treatment of hypertension. Other indications have since been studied and propranolol is now utilized for the treatment of performance anxiety, essential tremors, and the prevention of migraine headaches. Currently, studies are underway to determine the effectiveness of propranolol in the treatment of post-traumatic stress disorder. If the reason for the medication is not clear, consult the dentist or physician who ordered the medication.

Another reason to review the original containers is to verify the origin of the medications and supplements. Was the prescription filled by a pharmacy licensed in the United States or was it received from an overseas location? Was the prescription necessary for treatment of the patient? Low prices for medications can persuade patients to purchase medications online from questionable sources. Counterfeit medications are frequently purchased by patients. Those counterfeit products may include an incorrect dosage, the incorrect medication, or may be completely void of medication. The quality of the medication may also be questionable if it does not have an imprint on the pill to aid in identification, or if the packaging is delivered in an unidentifiable envelope.

Nonprescription medications can have significant adverse effects. Recent studies have implicated green tea extract, used in some over-the-counter weight loss products, as a major source of liver failure. The study, sponsored by the National Institutes of Health, notes that one out of five cases of hepatotoxicity in the United States are induced by herbal and dietary supplements.2

Your medication reconciliation process should also include possible effects on your patients regarding the use of nontraditional items used as medications or for recreation. For example, cannabis has been approved for medical use in several states. Consider the impact the use of cannabis or other nontraditional items might have on any medications you prescribe or administer in your office.

Preventing harm from the medications you prescribe or administer to your dental patients requires accurate medication reconciliation. Engage the patient as your partner in this important process.


References

  1. National Center for Health Statistics, Health, United States, 2016: With Chartbook on Long-term Trends in Health, Table 79, p293. Hyattsville, MD 2017, https://www.cdc.gov/nchs/data/hus/hus16.pdf, accessed June 2017.
  2. Navarro V, Ikhlas K, Bjornsson E, et al, Liver injury from herbal and dietary supplements, Hepatology, 2017;65:363-373, http://onlinelibrary.wiley.com/enhanced/exportCitation/doi/10.1002/hep.28813, accessed June 2017.

The guidelines suggested here are not rules, do not constitute legal advice, and do not ensure a successful outcome. The ultimate decision regarding the appropriateness of any treatment must be made by each healthcare provider in light of all circumstances prevailing in the individual situation and in accordance with the laws of the jurisdiction in which the care is rendered.

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