Important Secrets in the “Medication Sheet”

Mar 01, 2017

“Man is bad or good as he unites himself with bad or good spirits: tell me with whom you go and I’ll tell you what you do.”

William Blake

Important Secrets in the “Medication Sheet”

TISA Description of the Problem: Consultation and liaison work poses many unique difficulties. Time constraints are almost always tight and, unfortunately, the staff person who requested the consult is often not on the unit at the time one has appeared to do the consult. Fortunately, there is always a valuable resource available as the tip below emphasizes.

Tip: When I am asked to see a patient on the medical unit for the first time, before even looking at the chart, I check the medication sheet. There are more mistakes found on that sheet that can cause harm to the patient than any other area I have found in 24 years of practice. For example: patients suffering with dementia are often given benzodiazepines like they are candy, a practice that frequently causes the patients to become significantly worse.

TISA Follow-up: The importance of carefully reviewing the patient’s current hospital records, as described in the excellent tip above, has sometimes been called “interviewing the chart”. Along the same lines, when asked to provide consultation concerning the risk of suicide or violence, the chart can once again prove to be invaluable. In particular, it is useful to review the nursing notes over the previous several weeks. Nurses often detail comments made by the patient that are suggestive of suicidal or violent intent, as well as documenting transient periods of agitation or delirium that may predispose the patient towards such dangerous behaviors. Keep in mind that about 7% of suicides in the U.S. occur in hospitals.

Tip provided by:

Michael Alan Landau, M.D.
Kaiser Permanente
Bellflower, California

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Of preventing suicide and teaching clinical interviewing