One of the most interesting safety concerns in this patient was his risk for anemia and other mineral deficiencies due to being on pantoprazole. I knew that gastric acid help with digestion but I thought it had more to do with breaking up lipids, not with making other foods more available for your small intestine. At first, I almost didn’t include it because it doesn’t consistently lead to any clinical significance, but then I saw an interesting study that concluded that my patient was at risk due to having a history of anemia before the medication. I felt good about being able to identify that safety concern. It required knowing my patient and his medical history, research, and evaluation of that data to determine his risk. I felt like I was combining a lot of different aspects of “thinking like a nurse” and putting it into practice.
A different safety concern that I didn’t include in the final reconciliation was the patients use of a pill box organizer to store his medications for the week rather than keeping them in the pill box. I had seen people use organizers like that before but I wasn’t too certain on what the literature said on the matter so I was glad I was able to look into it. I saw that they can help when used correctly but if you sort your medications by day only and not by what time of day it’s supposed to be taken (as my patient does) that can interfere with its efficacy.
I also didn’t know that patients being given a generic version of the pill, or the manufacturer switching the tablet can create a safety risk because the patient can get forget about the change and get confused when they see a pill they don’t recognize in the container. This can be made worse if the patient has his wife or someone else sort his medications for the week rather than do it himself.
The patient knew why he was on each of his medications. This is important because the patient might be more compliant with his medication regimen if he understood what they were doing to help him and what could happen if stopped taking them. Due to the high cost of drugs it is not unheard of for patients to have to ration their medications. Being able to identify your cardiac meds from your multivitamin may prove to be an important piece of knowledge.
The patient was not on two medications that did the same thing but was on medications that worked together to help prevent similar issues. For example, the patients Lipitor and Metoprolol work in different pathways to lower cholesterol and blood pressure respectively. Although they achieve to different ends, they both work to prevent a heart attack in the patient due to arteriosclerosis or ventricular hypertrophy. If the patient was on two different medications that worked on the same pathway or ended in the same result, like two medications specifically to lower his blood pressure, that could have lead to significant hypotension which would be a safety risk.
