09 Patient Communication and Continuity of Medication Care

Explain medication plans clearly

Explain each new or changed medication in plain language, using current medication instructions and the patient's individualized plan. Cover the information the patient needs to use the medicine safely:

• Purpose: what the medication is for and what benefit to expect.

• How to take it: dose, route, timing, duration, food instructions, and administration technique.

• Effects and risks: common expected effects, important adverse reactions to report, and symptoms that need urgent attention.

• Precautions: relevant allergies, interactions, activities to avoid, and required monitoring or follow-up.

• Practical details: storage, refills, what to do about a missed dose, and whom to contact with questions.

Use short explanations, familiar words, and written instructions the patient can refer to later. Invite questions and use teach-back to check how clearly the plan was explained. For example, ask, “How will you take this medicine when you get home?” If the explanation is incomplete, clarify the instructions and ask again. For devices or administration techniques, ask the patient to demonstrate the steps, sometimes called a “show-me.”

Do not guess about missed doses or tell a patient to stop, restart, or change a medication without appropriate clinical direction. If a patient is unsure whether to take a late dose, help them contact the pharmacist or prescriber for medication-specific advice.

Support adherence without blame

Adherence means taking medication as agreed with the care team. A missed dose or a decision to stop or change treatment may signal a barrier, rather than lack of interest. Ask neutrally what makes taking medicines regularly difficult, then listen for the patient's specific concerns.

Common barriers include side effects, cost, difficulty understanding instructions, forgetfulness, trouble obtaining refills, and a complicated schedule. Work with the patient and appropriate team members to address the barrier; do not independently alter the medication regimen.

Depending on the situation, possible supports include reminders or a medication organizer, clearer written directions, help accessing a pharmacy or cost-assistance resources, or a medication review with a pharmacist or prescriber.

Document medication conversations

Follow organizational policy and scope of practice. Document information that is clear, objective, and useful to the next clinician, including:

• Medication information reviewed and any reported discrepancy, concern, allergy, or adverse reaction.

• Education provided, materials or interpreter support used, and the patient’s or caregiver’s response, including teach-back or demonstration when appropriate.

• The patient’s stated barriers or preferences and any agreed adherence supports.

• Questions or concerns escalated, whom you contacted, instructions or orders received, and actions taken.

• Follow-up plans, referrals, and whether updated medication information was communicated to the patient and relevant care team.

Record what the patient actually reported or demonstrated. Avoid unsupported judgments, such as labeling someone “noncompliant.” If an order or medication list is unclear, contradictory, or potentially unsafe, seek clarification and document the resolution according to policy.

Maintain continuity at care transitions

Medication reconciliation compares the medicines a patient was actually taking with current orders, resolves discrepancies, and communicates an accurate plan. Ask the patient or caregiver about prescription medicines, over-the-counter products, vitamins, supplements, and how the medicines are actually taken. Use other reliable sources when needed.

A reported medication list may differ from what was prescribed. Verify and clarify discrepancies rather than silently assuming either list is correct. This review is especially important during a care transition, such as admission, transfer, discharge, or movement between clinicians or facilities.

At a transition, work through these steps:

1. Compare the prior medication history with the new orders. Identify additions, stops, dose or schedule changes, omissions, duplications, or unclear instructions.

2. Clarify unintended or uncertain differences with the responsible prescriber or pharmacist. Document resolved changes and their rationale when available.

3. Give the patient or caregiver an up-to-date list and explain what changed and what to take next. Avoid vague directions such as “resume home medicines” when the specific plan is unclear.

4. Communicate the reconciled plan to the next care team. Arrange or explain needed monitoring and appointments, and tell the patient whom to contact about concerns.

For example, a patient’s home list may include a daily medicine that is absent from the discharge instructions. Do not assume it was intentionally stopped or tell the patient to restart it. Verify the plan with the responsible clinician, document the clarification, update the patient-facing instructions, and communicate the resolved plan to the next provider.