Medication reconciliation: Who do I talk with to review all my meds?

Posted by gcranor @gcranor, Aug 27 10:38am

Has anyone just got tired of taking so many medicines that they want to see what drug is causing other sign effects?
I am currently takeing;
Gabapentin 1800 mg daily
Metronic’s drug pump
Sumatriptan
Migraines monthly injections
Sterling
Purple pills for stomach
Tylenol 3000 mg daily

I want to stop all of them to see what I really need.

Any suggestions?

I know what the medical staff will say talk to you doctor, however I have 4 different doctors and I know they do not really read all the other doctors notes.

Interested in more discussions like this? Go to the Chronic Pain group.

@gcranor WAIT! I know what it feels like to be in pain, on a ton of meds, and not know "what to do" next. But…
Before you take a drastic action like this, you need to know how to safely make the change. Many medications must be tapered – stopping suddenly can cause physical withdrawal symptoms – a potentially dangerous or even fatal reaction. Others can cause psychological withdrawal symptoms – extremely unpleasant issues like mood swings, hallucinations, depression. Among those you need to be especially concerned about tapering are: gabapentin, pain meds from pump, Sumitriptan and Sterling (Sterane.)

If you really want to stop the medications, you need to find a clinical pharmacy specialist (may be a pharmacist or a specially trained nurse) or advanced practice pharmacist, who will work with you and your doctors to help identify potential drug interactions, age or condition related drug changes needed, and safe ways to taper off unwanted medications.

With such a wide array of medications, you will need a written taper plan, with regular follow-ups, to do this safely.

Are all of your specialists part of a single clinic and/or hospital system? If so, they may have someone who will have access to all of your records and be able to coordinate with your doctors. If not, you need help to find a professional to help with this.

Another option is to seek treatment in a Pain Rehabilitation Clinic, such as at Mayo, where they not only help get off the meds, but also work on other strategies for living with and managing your pain with fewer medications. You can read about it here: https://www.mayoclinic.org/departments-centers/pain-rehabilitation-center/sections/overview/ovc-20481691

Do either of these options sound like something you can do?
Sue

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Mayo in Minnesota takes different approaches to drugs for pain. Dr. Charles Loprinzi who is an oncologist by trade is one of the foremost authorities on chemo induced neuropathy in the United States. I have read about his work for years in alternative pain treatment including scrambler therapy. MD Anderson in Houston and John Hopkins in Maryland also are working very hard to find treatments that are not drug based for pain.

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Hi @gcranor , You will notice I changed your title to better communicate what it is you are looking to do. Medication reconciliation is the process of comparing a patient's medication orders to all of the medications that the patient has been taking. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. Transitions in care include changes in setting, service, practitioner, or level of care. This process comprises five steps: (1) develop a list of current medications; (2) develop a list of medications to be prescribed; (3) compare the medications on the two lists; (4) make clinical decisions based on the comparison; and (5) communicate the new list to appropriate caregivers and to the patient.

You may also want to look at some of these articles:
"A geriatrician explains a 5 step process that family caregivers can use, to review a senior's medications for safety & appropriateness." — How to Review Medications for Safety & Appropriateness in Aging: https://betterhealthwhileaging.net/how-to-review-medications-for-safety-appropriateness/

Medication errors: Cut your risk with these tips: https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/medication-errors/art-20048035

I highly recommend Sue's option, to seek treatment in The Pain Rehabilitation Clinic. I have been there myself and they corrected all the problems I had with multiple medication for my chronic pain.

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I am being treated by the VA and they would not approve me going to the Mayo site. It’s so hard to get everything reviewed and treated completely.

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@gcranor. Sorry for the ignorance, with the VA healthcare system, do you have choice of doctors outside of the VA? Where are you located, maybe someone has resources they can share for in or outside of the VA system.

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I have been able to use community care for a few doctors; however they don’t communicate with doctors in the VA and my doctors under community care. When I asked for doctors to setup an appointment with all the doctors to get a single direction of care. That didn’t work the Neurologist said we don’t need that and he said he reviewed everything but he didn’t believe the other neurologist specialist and went his direction.

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@gcranor

I have been able to use community care for a few doctors; however they don’t communicate with doctors in the VA and my doctors under community care. When I asked for doctors to setup an appointment with all the doctors to get a single direction of care. That didn’t work the Neurologist said we don’t need that and he said he reviewed everything but he didn’t believe the other neurologist specialist and went his direction.

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@gcranor I'd imagine if you had a setup for a 2nd opinion you'd only need to sign for a release of information to transfer your records. Your situation doesn't seem fair when they won't do what you are asking, but that's only my observation.

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@gcranor

I have been able to use community care for a few doctors; however they don’t communicate with doctors in the VA and my doctors under community care. When I asked for doctors to setup an appointment with all the doctors to get a single direction of care. That didn’t work the Neurologist said we don’t need that and he said he reviewed everything but he didn’t believe the other neurologist specialist and went his direction.

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If they can't accommodate your needs for a complete reconciliation within the acceptable time frame, you are entitled to a community option. Also, unless they can offer an option to help you reduce your many pain meds, you may be entitled to a community option other than Mayo. Your state or county has a Veterans Service organization to help you. If you don't have the necessary contact info, get in touch with your local VFW or Legion post to get the number. I get your frustration with the VA and the lack of continuity. If you are eligible for Medicare and live where there are good medical options, you may want to check into a Medicare Supplement or Advantage Plan during Open Season. We know a number of people who have done this so they can manage their own care.

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@amandaa

Hi @gcranor , You will notice I changed your title to better communicate what it is you are looking to do. Medication reconciliation is the process of comparing a patient's medication orders to all of the medications that the patient has been taking. This reconciliation is done to avoid medication errors such as omissions, duplications, dosing errors, or drug interactions. It should be done at every transition of care in which new medications are ordered or existing orders are rewritten. Transitions in care include changes in setting, service, practitioner, or level of care. This process comprises five steps: (1) develop a list of current medications; (2) develop a list of medications to be prescribed; (3) compare the medications on the two lists; (4) make clinical decisions based on the comparison; and (5) communicate the new list to appropriate caregivers and to the patient.

You may also want to look at some of these articles:
"A geriatrician explains a 5 step process that family caregivers can use, to review a senior's medications for safety & appropriateness." — How to Review Medications for Safety & Appropriateness in Aging: https://betterhealthwhileaging.net/how-to-review-medications-for-safety-appropriateness/

Medication errors: Cut your risk with these tips: https://www.mayoclinic.org/healthy-lifestyle/consumer-health/in-depth/medication-errors/art-20048035

I highly recommend Sue's option, to seek treatment in The Pain Rehabilitation Clinic. I have been there myself and they corrected all the problems I had with multiple medication for my chronic pain.

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Thank you Amanda as this was confusing for me as a retired nurse!

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@gcranor

I am being treated by the VA and they would not approve me going to the Mayo site. It’s so hard to get everything reviewed and treated completely.

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The VA has approved Calmare Therapy-Scrambler Therapy for your problem for those treated by VA doctors. Scrambler therapy is non drug and been around for years and has helped people with your problem. I found info for you on internet by googling VA and scrambler therapy.

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I will check it out. Thank you

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@sueinmn

@gcranor WAIT! I know what it feels like to be in pain, on a ton of meds, and not know "what to do" next. But…
Before you take a drastic action like this, you need to know how to safely make the change. Many medications must be tapered – stopping suddenly can cause physical withdrawal symptoms – a potentially dangerous or even fatal reaction. Others can cause psychological withdrawal symptoms – extremely unpleasant issues like mood swings, hallucinations, depression. Among those you need to be especially concerned about tapering are: gabapentin, pain meds from pump, Sumitriptan and Sterling (Sterane.)

If you really want to stop the medications, you need to find a clinical pharmacy specialist (may be a pharmacist or a specially trained nurse) or advanced practice pharmacist, who will work with you and your doctors to help identify potential drug interactions, age or condition related drug changes needed, and safe ways to taper off unwanted medications.

With such a wide array of medications, you will need a written taper plan, with regular follow-ups, to do this safely.

Are all of your specialists part of a single clinic and/or hospital system? If so, they may have someone who will have access to all of your records and be able to coordinate with your doctors. If not, you need help to find a professional to help with this.

Another option is to seek treatment in a Pain Rehabilitation Clinic, such as at Mayo, where they not only help get off the meds, but also work on other strategies for living with and managing your pain with fewer medications. You can read about it here: https://www.mayoclinic.org/departments-centers/pain-rehabilitation-center/sections/overview/ovc-20481691

Do either of these options sound like something you can do?
Sue

Jump to this post

Yes, thank you

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