Overview
The "Brown Bag Medicine Review" is a common practice that involves encouraging patients to bring all 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 uncover medicine errors and medicines missing from your list. Many practices conduct medicine reconciliation using information in the medical record or as reported by the patient. However, it is only by having patients bring in their medicine containers and discussing how they take those medicines that you can tell whether and why patients are not taking medicines correctly.
Practice Experiences
"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."
Actions
Identify medicines patients should bring.
- All prescription medicines.
- All over-the-counter medicines.
- All vitamins, supplements, and herbal medicines.
- All topicals, liquids, injections, and inhalants.
- All pills—both the bottles they came in and pill box organizers.
Remind patients to bring all medicines.
Ask patients who have not had a medicine review in the past year, or who have changed their medicines recently, to bring in all their medicines. Use Role Play 1 from the appendix to practice.
- Discuss medicine review during a visit and encourage patients to bring medicines to the next visit. Emphasize the potential benefits (e.g., possible reduction in number of medicines).
- Print a reminder on appointment cards.
- Mention it during appointment reminder calls.
- At checkout, provide the Medicine Review Handout and a carrier, such as a bag with your practice's name and "Bring All Your Medicines" printed on it, and ask them to bring all their medicines to their next appointment.
TIP
Every patient can benefit from a Brown Bag Medicine Review. Some patients may need a brown bag review several times a year, but every patient should have one once a year. Even patients for whom your clinicians have not written any prescriptions could be taking medicines or supplements clinicians do not know about.
Prepare for the review.
- Decide who will conduct the review—the primary care clinician, pharmacist, or nurse.
- Rooming staff can ask patients to set out all the medicines.
Perform the review.
- Thank patients for bringing in their medicines.
- When reviewing each medicine, ask questions like:
- "When do you take this medicine?"
- "Could you please show me how you take this medicine?" Have them:
- Remove pills from bottles and show how many they take for each time they take them or talk you through the pill box.
- Use syringes or pour liquid medicines to show the dose.
- Demonstrate how they use inhalants and injectables.
- Have you had any difficulty buying or taking any of your medicines?
- Probe whether the patient takes other medicines or supplements that they did not bring in. Specifically ask about medicines that are in the medical record that the patient did not bring in, as well as any over-the-counter medicines and vitamins, supplements, and herbal medicines.
- Throughout the process, use the word "medicine," rather than "medication." Medicine is a common word that is easy for patients to understand.
- Clinicians should deprescribe medicines that patients do not need any more or are causing more harms than benefits. Turn on in your electronic health system. Check to reduce doses or discontinue medicines safely.
TIP
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 will not lecture them if they tell you what they are really taking.
Uncover problems and provide patients with support.
When you find that patients are taking medicines incorrectly, try to find out why.
- Patients may have gotten conflicting information or misunderstood. Clarify directions using common, everyday words and precise instructions (e.g., "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.
- Find out if patients have difficulty paying for medicine. Use Tool 19: Help Patients Pay Less for Medicine to learn how to reduce medicine costs and get patients help.
- Patients may have difficulty reading labels or instructions. Check if they need glasses, but patients who claim they forgot their reading glasses may be hiding a literacy problem. If reading or math is the problem, use Tool 20: Connect Patients with Literacy and Math Resources.
- Patients may have difficulty remembering how to take their medicine. Tool 16: Help Patients Take Medicine Correctly has examples of easy-to-understand medicine lists and ways to help patients remember how to take their medicines correctly.
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.
Research Findings
After implementing this tool, practices saw marked increases in the number of:
Patients who brought all their medicines to visits: from 20% to 67% for prescription medicines and from 9% to 20% for non-prescription medicines.
Medicines brought to the visit from 1 to 6 medicines, on average.
Patients whose medicine regimen were changed as a result of the review from 18% to 42%.
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Track Your Progress
Calculate the below measures 2 months, 6 months, and 12 months after implementing this tool. See if the numbers change over time.
- Percentage of patients who brought in their medicine whose medicines were reviewed. For a week, ask patients at checkout if they brought in their medicines for a Brown Bag Medicine Review. If they have, ask if the review was performed.
- Percentage of patients with office visits who had a Brown Bag Medicine Review in the past 12 months. Use patient medical records to calculate.
Have clinicians complete the Medicine Review Form for a sample of patients who have brought medicines to review to calculate the following. Note: remove any questions from the Medicine Review Form relating to measures that you do not want to track.
- Percentage of patients who brought all their prescription medicines.
- Percentage of patients who brought all their over-the-counter medicines and supplements.
- Percentage of patients who were unable to show correctly how and when they took at least one medicine.
- Percentage of reviews that identified any kind of problem.
- Percentage of reviews that identified a problem that definitely or possibly posed a safety risk.
- Percentage of reviews that identified a problem that definitely or possibly explained negative symptoms the patient had been experiencing.
- Percentage of reviews resulting in a change to the medicine regimen.
- Percentage of reviews resulting in simplifying the medicine regimen.
- Percentage of reviews resulting in reducing the number of prescription medicines.
Before implementing this tool and 2, 6, and 12 months later, collect patient feedback on a selection of questions about this tool from the Health Literacy Patient Feedback Questions.
Refer to Tool 2: Assess Organizational Health Literacy and Create an Improvement Plan to learn how to use data in the improvement process.
