Your patient may be taking duplicate meds

You'll need to "play detective"

When a woman reported depression, migraines, and slurred speech over a period of months to Casie McMaster, RN, an ED nurse at St. Anthony's Hospital in St. Louis, MO, she reviewed her patient's home medications.

"I noticed she had several bottles of amitriptyline. She had been prescribed this drug twice, by two different doctors," she says.

While the normal dose for migraine treatment is 10 mg per day, says McMaster, the normal dose for depression is 150 to 300 mg per day in divided doses. "I soon found out she was taking 450 mg a day in three doses, which put her 150 mg over the recommended dose per day," she says. "Her doctors had no idea what the other was prescribing."

The woman was taking three times the intended amount of the medication, says McMaster, which was making her drowsy and causing slurred speech. "This is an example of a huge discrepancy that could have been easily avoided if her primary medical doctor and psychiatrist would have communicated, or had the ability to compare what each was prescribing," says McMaster.

Medication reconciliation is often a frustrating task for ED nurses, since they need to "play detective" to figure out what a patient is taking, says McMaster.

To avoid discrepancies, McMaster says to compare the medications your patient is currently taking to what medications will be given in the ED or prescribed to a discharged patient.

"Patients are so ill or overwhelmed they don't think to tell us everything," says McMaster. "As your patient's advocate, make sure you have turned every stone prior to prescribing." (See clinical tip on previous medications, below.)


For more information on medication reconciliation in the ED, contact:

  • Casie McMaster, RN, Emergency Department, St. Anthony's Hospital, St. Louis. Phone: (314) 525-4558. Fax: (314) 525-4868. E-mail:
  • Donna Sparks, MSN, RN, CEN, CNABC, Director of Emergency Services, Baptist Hospital of Miami (FL). Phone: (786) 596-7336. Fax: (786) 596-7995. E-mail:

Clinical Tip

Check if patient still takes previous meds

Reviewing your patient's previous medical records will tell you the medications he or she was taking at the time he or she was discharged, but the patient might have discontinued taking some of these, says Donna Sparks, MSN, RN, CEN, director of emergency services at Baptist Hospital Miami (FL). "A pitfall is possible if the nurse were to list the old medications as the patient's current medications without validation," says Sparks.