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The "Brown Bag Review" of medicines is a common practice that involves encouraging patients to bring all of their medicines and supplements to their visit and reviewing them. The goal is to determine what medicines patients are taking and how they are taking them. The process can identify medicine errors and misunderstandings that would otherwise be overlooked. Although many practices conduct medicine reconciliation using information in the medical record or as reported by the patient, a Brown Bag Medicine Review is more thorough.
"Out of 10-15 brown bag reviews, only 2 were accurate."
"On the day of the brown bag review, we had a patient experiencing unexplained symptoms. It wasn't until we looked at his medicine bottles that we realized he was taking a double dose of beta blocker. Had we not had the medicine bottles to identify the problem, we would have sent him to the hospital."
One family medicine practice chose to create reusable medicine bags with their name and logo on them and asked patients to bring in their medicines and vitamin supplements to each visit. The Health Literacy Team Leader noted "…I think it just makes the patients feel like we care about every aspect of their visit. Not just, you know, their diagnosis and getting them in and out, but …taking time with them."
Identify medicines patients should bring.
- All prescription medicines.
- All over-the-counter medicines.
- All vitamins, supplements, and herbal medicines.
- All topicals, liquids, injectibles, and inhalants, as well as pills.
Remind patients to bring medicines.
- Discuss medicine review during a visit and emphasize the potential benefits (e.g., possible reduction in number of medicines).
- Write a note on the appointment card.
- Mention it during the appointment reminder call.
- Hang posters in the exam room and waiting room.
- Provide a carrier, such as a bag with your practice's name and "Bring All Your Medicines" printed on it.
Every patient can benefit from a Brown Bag Medicine Review. Even patients for whom your clinicians have written no prescriptions could be taking medicines or supplements you need to know about.
Prepare for the review.
- A nurse or medical assistant can set out all the medicines at the beginning of a visit.
- The staff member should thank patients for bringing in their medicines.
Perform the review.
- Ask the patient to pick up each medicine bottle, and ask the patient:
- What do you take this medicine for?
- When do you take this medicine?
- Can you show me how much you take each time?
- Throughout the process, use the word "medicine," rather than "medication." Medicine is a common word and is more likely to be understood by patients.
Clarify medicine instructions.
- When you find that patients are taking medicines incorrectly, try to find out why. Clarify what they should be doing. Use common, everyday words and provide precise instructions ("Take 1 pill in the morning and 1 pill at bedtime.") Go to Tool 4: Communicate Clearly for tips for communicating in a way that will be easy to understand.
- Use the Teach-Back Method to confirm patient understanding. Go to Tool 5: Use the Teach-Back Method for guidance.
Patients may have understood your instructions, but decided not to take their medicine as directed. Patients will tell you what they think you want to hear unless you signal that you won't lecture them if they tell you what they're really taking
Document the review.
- Update the medicines in the patient's medical record.
- Document medicine inconsistencies and what the patient has been directed to take.
- Note in the record when medicine reviews are done.
Provide patients with updated medicine lists.
- Patients should leave the visit with an updated list that describes what medicines they should take and how.
- Go to Tool 16: Help Patients Remember How and When to Take Their Medicine for examples of easy-to-understand medicine lists and ways to help patients remember how to take their medicines correctly.
Track Your Progress
At checkout, ask patients if they brought in all their medicines for a Brown Bag Medicine Review. If they have, ask if the review was performed. Calculate the percentage of all patients who brought in their medicine over the past month and the percentage of those patients whose medicines were reviewed.
Monitor patient medical records on a routine schedule (e.g., monthly) to calculate the percentage of patients seen during that period who had a Brown Bag Medicine Review.
Have clinicians complete the Medicine Review Form for a sample of patients 2 months, 6 months, and 12 months after implementing this tool. Using data from the form, calculate the percentage of patients that brought all their medicines and the percentage of reviews that identified a problem. See if the numbers change over time.
If you field questions from the Health Literacy Patient Survey, calculate what percentage of patients responded "Always" to question #12.
The American Medical Association (AMA) manual "Health Literacy and Patient Safety: Help Patients Understand" offers information on medicine reviews. Once you link to the Web site, look for the Manual for Clinicians. Access to the manual is free, once you have created an account.
The Brown Bag Tool Kit, from the Ohio Patient Safety Institute, contains information for practices related to planning a Brown Bag event with pharmacies.