Collaborate with pharmacist to manage complex cases

Seek help for patients on multiple medications

When a patient is admitted to the hospital with a chronic condition such as pain, one of the key elements of assessment is to determine what medications — including prescriptions drugs and nonprescription medications and supplements — the individual is taking. It is not uncommon for some patients, particularly older adults, to take 10 or more prescription medications a day.

Medications that are taken daily may not be the sum total of what has been prescribed by various doctors for the patient. There may be additional prescriptions that have not been filled. Patients may arbitrarily decide not to take a particular medication because they do not know what it's for, they consider the drug to be too expensive, or they have concerns or questions or are afraid of addiction. Further, some medications may be taken less frequently or more frequently than prescribed.

The number of prescriptions, the need to manage multiple medications with varying doses, and the possibility of contraindications raises the need for a pharmacist to be part of the case management team. A pharmacist can provide expertise about particular medications and combinations of medications. In addition, medications may affect older adults differently than other patients.

Through collaboration to manage complex cases, hospital case managers should seek a pharmacist's input. A pharmacist can review all prescriptions that have been prescribed, as well as nonprescription medications and supplements, and provide information or raise concerns about drugs that may not be as effective or that may have undesirable or high-risk side effects.