Medication Safety and Polypharmacy

Medication safety and polypharmacy are two critical issues that can impact the care of patients with heart failure. Many patients with heart failure are on multiple medications for their heart failure, and also for their other co-morbidities. In the review of possible gaps in care and reasons for readmission, the team may identify a variety of medication-related patient safety issues:

• Review of respective patient medications for use of ACI and ARBs when appropriate. 
• Review of patient medications for use of Warfarin when appropriate.
• Appropriate use of beta blockers on discharge when applicable.
• Review of respective patient medications for medications that may exacerbate heart
• Use of appropriate monitoring system for patients newly started on ACEI/ARB or spironolactone.
• Review of patient medications that can be safely discontinued.
• Use of a transparent medication reconciliation system for Hospital Discharge, the congestive heart failure patient and the primary care physician’s office.
• Appropriate monitoring and documentation of patients being administered diuretics.

The Potentially Hazardous Interactions for Heart Failure Patients Reference Guide in the Clinical Tools section contains a brief list of important drug interactions and cautions regarding use of specific medications in patients with heart failure.  Recognizing these safety issues must also be translated into the patient education provided by the health care team.  The Medication Education for Heart Failure Patients Reference Guide in the Clinical Tools section contains an info sheet on talking with patients about medications and helping them to be aware of the medication safety concerns.