General Helpful Hints

Documentation

• Create new data fields and key codes in EMR making documentation easier.
• Insert a documentation form on the inside front cover of the patient chart to document that a discussion was held and a handout distributed.
• Insert paper reminders, e.g. on lab slips. Also, EMRs offer a number of imaginative reminders in the software.

Documentation of Side Effects

• Modify the progress note format to trigger and easily document discussions of medication risks and benefits.

Documentation of Laboratory Monitoring

• Place a scoring system in each chart, designed to stratify patients according to their risk for GI bleeding. Offer PPI therapy as appropriate and document acceptance/ refusal of therapy on the same page as the scoring system.
• Creation of a standard charting mechanism should improve attention to, and documentation of, risk and benefit discussions when starting new medication, or for assessing risk for GI bleeding and prescribing appropriate gatroprotective agents. These documents will actually extend beyond the care of gout patients, but will be relevant to any patients receiving any new medication and/or for any patient receiving NSAID therapy.

Patient-Physician Communication

• Physician education is integral regarding the importance of talking to patients about drug safety.
• The more a patient understands how and why physicians use the various drug treatments and the risks and benefits, the more they are likely to be compliant and to use the drugs safely; therefore it is essential to hold these communications with patients.

Risks for Drug Safety / Medication Toxicity

• In the EMR, create pre-constructed text which could be entered with a single keystroke that risks and benefits of medications have been discussed.
• Review potential side effects with patients verbally or use a patient education handout, or both.
• Review risks if practice assumes primary care of patients with prescriptions already provided by another physician.
• Generate awareness of co-morbid risks and prescriptions of prophylactic medication when appropriate.
• Review pertinent labs in any dictation that describes the prescription of one of the gout medications under review.

Handouts

• Offer an ACR handout which describes the medications and risks and benefits relevant to gout.
• Design a gout quiz for testing patient knowledge to be completed in the waiting room.
• Discuss with and distribute a handout to patients that are on medications from a prior visit (either from a previous physician or not) that may not necessarily be documented.