■ The healthcare system:
Building safer systems to enhance clinical care delivery
Plan for safety: Monitoring a patient for medication toxicity
Type of activity: Text case
This text case describes a patient who suffers medication-related toxicity. The facilitation questions and suggestions to faculty focus on helping learners to identify medication risk factors for patients and to consider strategies for minimizing such risks.
A 72-year-old woman with a history of bipolar disorder and hypothyroidism is treated with lithium and thyroxine. The patient is subsequently diagnosed with hypertension and her family physician is considering initiating a diuretic. The physician is aware of the potential for interaction between lithium and diuretics.
- What should the physician discuss with the patient about the proposed treatment plan?
- How should the physician document the decision to treat/not to treat?
- What would you include in the discharge instructions?
- What would you include about the therapeutic plan in the clinical documentation?
Suggestions to faculty
Ask learners to identify the 3 elements of informed consent and to describe the key information that should be documented following a consent discussion. Also discuss key information that should be included in discharge instructions such as (but not limited to) required follow-up, read-back, safety netting, and red flags for patient self-monitoring.
CanMEDS: Medical Expert,