OASIS Alert

Gather your thoughts with this handy form before contacting the physician.

Ready to give the SBAR approach a try? This form from Mary Narayan, MSN, RN, HHCNS-BC, COS-C, with Narayan Associates in Vienna, Va. will help you to address medication issues and prevent unwanted hospitalizations.

                    Communication with Physician about
Medication Issues/Discrepancies during Reconciliation/Review

Situation:

• Dr. (name), this is (your name, discipline) from (name of your home health agency).
• I am calling about (patient’s name), whose medication reconciliation indicates: (Examples include:)

 serious medication discrepancies.

 patient has symptoms indicating possible medication adverse effect.

 current medications are not adequately controlling patient’s (pain, BP, infection, etc.)

 patient not taking medication due to cost of medication.

Background:

• Patient’s age ______
• Reason admitted to home care __________________________________ Date admitted ____________
• Diagnoses related to medication discrepancies/issues:________________________________________

Assessment: (Only report abnormal/pertinent data)

• During the admission medication reconciliation, I found the following discrepancies: _________________________________________________________________________________________________________________________

________________________________________________________________________________________________

• Patient’s symptoms include:

 Dizziness, lightheadedness  Visual changes  Ringing in ears

 Insomnia  Lethargy  Difficulty breathing

 Nausea/anorexia  Constipation  Diarrhea

 Itching  Difficulty urinating  Urinary frequency

 Other pertinent symptoms ________________________________________________________

• Physical assessment:

 Vital signs: Pulse _______ RR ________ BP _________ Orthostatic BP _______

 O2 sat ________ Blood glucose: __________ Edema/swelling ______________

 Neuro:  Altered mental status  Balance problem  Tremors

 Skin:  Rash  Hives  Excessive bruising

 GI:  Dry mouth Vomiting Tarry stools

 Other pertinent data: ______________________________________________

• Analysis:

 Ineffective drug therapy  Adverse effect  Side effect

 Reconciliation discrepancies  Drug interaction  Duplicate therapy

 Non-adherence due to:  Cost  Confusion

 Complexity of meds  Other __________________

Recommendation: Examples include:

• Since these medication discrepancies could jeopardize the patient’s safety, could you return the Medication Profile I have faxed to you, with your clarifications and revisions, by 10 am tomorrow?
• Should the dose of the (medication name) be decreased or discontinued?
• I recommend we ask the pharmacist to review the patient’s medication list for recommendations on how the medication regime can be simplified.

Note: This form ©2012, Mary Curry Narayan. Reprinted with permission.