Medication: Safety & Polypharmacy

By Chad Whelan, MD

Patients admitted with ACS often require complex medication regimens throughout their hospitalization and while transitioning to discharge. In addition to the medications that are primarily for ACS, these patients will often have comorbid conditions such as diabetes, hypertension, or congestive heart failure that all require several medications independently. In addition, many patients admitted with ACS are elderly, and the risk of side effects and the dangers of polypharmacy are increased in the elderly. Thus, the safe use of these complex regimens will be an important part of your standardization of care.

There are several key steps to consider to maximize medication safety and minimize unnecessary polypharmacy. These can include:

• Use a standard approach to verify medication reconciliation as the patient moves throughout the hospitalization, from ED to DC.
• Develop standard protocols for drug monitoring when appropriate, such as when using standard heparin nomograms and automated platelet checking for patients on heparin.
• Maintain appropriate drug–drug interaction checking, especially for those drugs likely to be used in these patients, such as beta-blockers and negative chronotropic calcium channel blockers or ACE I and spironolactone.
• Use the medication reconciliation process as an opportunity to discontinue medications no longer required.
• Assure that appropriate monitoring systems are in place for patients being discharged on medications that require such monitoring.
• Provide a complete list of medication and indications to the patient and the physicians seen in follow-up. 

Providing patients with written information about their new medications can be very useful. See the Clinical Tools section for resources you might be able to use to provide your patients with this type of information.