Medication review

1. Patient Interview and History

Gather information on patient demographics, medical history, allergies, lifestyle, and medication adherence.

Discuss current symptoms, treatment goals, and concerns about medications.


2. Comprehensive Medication List

Review all medications, including:

Prescribed drugs

Over-the-counter medications

Herbal products and supplements


Document dose, frequency, route, and duration.


3. Clinical Assessment

Evaluate each medication for:

Indication: Is there a valid reason for use?

Effectiveness: Is it achieving its intended outcome?

Safety: Any side effects, contraindications, or interactions?

Adherence: Is the patient taking it as prescribed?



4. Identification of Drug-Related Problems (DRPs)

Common issues include:

Unnecessary medications

Dosage too high or too low

Drug interactions

Adverse drug reactions

Duplication of therapy

Poor compliance

Need for additional therapy


5. Laboratory Data Review

Interpret lab results (e.g., kidney/liver function, blood glucose, INR) to assess medication appropriateness and safety.


6. Optimization and Recommendations

Suggest:

Changes in therapy (adding, stopping, switching, or adjusting medications)

Monitoring parameters

Non-pharmacological advice


Collaborate with physicians and healthcare providers.


7. Patient Education

Counsel on:

Purpose and correct use of medications

Potential side effects and how to manage them

Importance of adherence and lifestyle modifications



8. Documentation and Follow-Up

Record findings, decisions, and communication in the patient’s health record.

Schedule follow-up to reassess and monitor outcomes.