Primary Care MedRec Guide

Joan is a 78-year-old woman whose husband died over a year ago. Soon after, her family doctor diagnosed Joan with depression and anxiety and prescribed citalopram 40 mg orally once a day and lorazepam 0.5 mg orally every 6 hours as needed. Joan has been taking these medications for the past year. She has also been experiencing muscle cramps in her legs while sleeping. Her family doctor referred her to an orthopedic surgeon to assess the leg cramps, and the surgeon prescribed quinine to treat the cramps. Joan took the prescription to her regular pharmacy, but the pharmacist told her that the medication was not covered by her insurance plan. The pharmacist then called the surgeon to ask that the medication be switched to one that was covered. The surgeon decided to prescribe chlordiazepoxide at bedtime instead. The pharmacy filled the prescription, but 2 days after starting the medication, Joan mentioned to her daughter that she was feeling somnolent well into the daytime hours and that she did not feel comfortable driving. Joan's daughter searched for information about the medication on the internet and found that Joan was probably experiencing an interaction between the new medication and the citalopram and lorazepam. Joan's daughter recommended that she stop taking the medication and follow up with her family doctor right away.

In this story, there were several opportunities when actions could have been taken to prevent Joan's ill effects (i.e., the adverse drug event). Many of these opportunities relate to appropriate communication of a patient's current medication regimen.

• In the referral letter to the surgeon, did Joan's family doctor include a complete list of all the medications that Joan was taking?
• During the visit did the surgeon ask Joan about all the medications she was taking?
• When requesting an alternative therapy, did the pharmacist list for the surgeon all the medications that Joan was taking and/or did the surgeon ask the pharmacist for the list of medications?
• Did the pharmacist ask the Joan if there had been any recent changes to her medications before dispensing the new medication?