Side effect list

[PikminOC]

In this world of increasing documentation, I was wondering if anyone prints out side effects of medications, goes over them with patients, and has the patient sign a copy for the chart? I am looking for premade side effects lists for each class of medications b/c the product information is too detailed and some websites are not detailed enough.

Thanks!

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[hippiedoc13]

In this world of increasing documentation, I was wondering if anyone prints out side effects of medications, goes over them with patients, and has the patient sign a copy for the chart? I am looking for premade side effects lists for each class of medications b/c the product information is too detailed and some websites are not detailed enough.

Thanks!

If you are looking for something pre-made, the NAMI website has a number of excellent patient education handouts on about 2 dozen of the most commonly prescribed psychiatric medications. I frequently print these out for my outpatients and review the salient points, then document in my note "Discussed r/b/se with patient, specifically including x, y, and z, and provided pt with written handout summarizing this information. Pt demonstrated [good/fair/etc] understanding of this information and gives informed consent to take this medication." And then I have them sign my clinic's generic medication consent form, on which I fill in the name of the medication(s) and check the box indicating that I provided them a written handout and verbally reviewed the information. We both sign, and a copy goes into their chart.

In our inpatient setting, we are also required to document consent (or refusal, as the case may be), and on the consent form we have to document discussion of the most common and serious side effects. The patient signs the consent, which comes in duplicate or triplicate, and one copy goes to the patient and the other into the chart.

I've never personally had the patient physically sign the actual educational handout on the drug, if that's what you're asking about.

My two favorite resources are the NAMI website, and UpToDate pt education section. I would say the one downside is that much of the material is written at least at an 8th grade reading level, if not a little higher, and I have many patients who almost certainly don't read at that level.

One of my next projects (in all my free time) is actually going to be putting together a "library" of all my favorite pt info handouts, the best one I can find for each drug I commonly use, and possibly writing a few of my own for the drugs for which I can't find good handouts that I like.

 

[PikminOC]

Thanks for the info hippiedoc. I will look forward to getting the information you start putting out.

I went on the NAMI site under medication. Its very good but longer than 1 page. Do you hand the patient the whole printout? And do you print it out each time or just keep copies in file folders?

I have been working inpt since residency ended and will now be doing outpt and consults so any help is appreciated. The risk in oupt can be high and I am trying to minimize this.

 

[whopper]

Consumer Reports makes a guide to antidepressants that I have found extremely useful. It highlights the side effects, costs, benefits, etc of all of the newer antidepressants (meaning Prozac onwards). In fact, IMHO, the guide clarifies several things about antidepressants that most M.D.s, even psychiatrists do not know that are highly useful for patients.

The guide can only be obtained by an online subscription to CR but I do have it in PDF format.

CR also wrote a guide to antipsychotics, but I found myself disagreeing with some of the comments in that guide. Those comments were not false. They were within an area where two doctors could disagree with the interpretation of the results from existing data.

For my inpatients, I often use the hospital's medication guide where we could easily print them up for the patient.

For my outpatients, I often refer them to drugs.com or epocrates.com. I do inform the patient to not be fearful when they see a list of several dozen possible side effects. I specifically tell them that every medication has dozens of possible side effects and most of them rarely occur. You will though, have to give the patient a brief guide on the most likely and the most dangerous side effects of a medication that will be useful to them. I also mention to avoid using anything you could find on google because there are several misinformation sites funded by the Church of you know who concerning psychotropic medications.

 

[Doc Samson]

There's this book from APPI:

http://appi.org/SearchCenter/Pages/SearchDetail.aspx?ItemId=62356#

Includes handy CD-ROM from which you can print the handouts.

 

[kugel]

MDConsult has a printable pt ed form for most medications and diagnoses, and allows you to personalize a header. Many are also available in Spanish. Wouldn't be bad to print out 2 copies, have pt sign one for the chart.

If you are practicing in an organization or group, ask the Medical Director how this should proceed. If you are in a residency or hospital or public agency, ask the Director and/or Risk Mgt attorney how they would like you to proceed. If you are in private practice, find several such options and print them out, then ask your malpractice carrier's Risk Mgt attorney which of the various options he/she thinks you should pursue. If (part of) your goal is to avoid getting sued, ask a Risk Mgt Attorney.

Do you give any printed instructions at the end of every visit, sort of like the discharge instructions ER patients are given? I've always thought this was useful in outpt settings. I had a 1-pg form that allowed me to write in their next appt, how to take any new meds, what meds to stop, other appts to make (PCP, lab, ect), reminder not to use drugs/alcohol, where to go/call in an emergency, etc. If anyone else had to follow-up after me, they knew EXACTLY what I'd told the patient by the copy in the chart.

I can't remember what my own PCP says if I don't write it down.

 

[whopper]

The trial of Canterbury v. Spence setup a legal mandate that clarified that physicians must inform their patients of the risks and benefits of a treatment.

Despite that, most patients I know, including my wife tell me their doctor just gave them a pill and told them to call them if there's a problem. No explanation, no warnings of side effects, etc.

I always get told, but I think it's because I'm a doctor. I noticed that several medical providers tended to do a "real" job when the patient as a doctor or a lawyer. Why is obvious, especially with the lawyer.

 

[hippiedoc13]

Wow, Consumer Reports has stuff on psychotropic medications? From the name I just always imagined they only had info on, like, toasters and baby strollers and cars and stuff...

The amazing things I learn from SDN! 🙄