Team Up! Team-based primary and community care in action

In episode 9 of TeamUP!, the focus is on exploring the integral role nurses play in medication management within primary care teams.
We will hear interview clips from Kacey, a registered nurse, who explains the responsibilities nurses hold, including taking comprehensive medical histories, assessing medication impacts, advocating for patients, and educating them about their medications. The discussion highlights the value nurses add during transitions of care and their ability to address sensitive topics, such as financial challenges, which may affect medication adherence. Nurses build patient trust, provide follow-up education, and work collaboratively within the team to enhance patient care.

Special Thanks
============
Throughout this season you’ll hear from several amazing nurses:
  • Angela Wignall is a Registered Nurse who has worked in perinatal health and public health. Since recording this episode Angela has been promoted to the CEO of the Nurses and Nurse Practitioners of BC from her position as Senior Executive Director. Angela is also a board member at the Canadian Nurses Association.
  • Diana Boateng is a Registered Nurse and is working on her dual master’s degree in nursing and health informatics. In her Masters, she is a co-op student working with the Innovation Support Unit. Her background is mostly in acute care but she has been interested in exploring what it means to be a nurse in primary care.
  • Hannah Roy works as a Registered Nurse in primary care and urgent primary care. She has certified practice in STI management and is completing her Masters degree to be a nurse practitioner.
  • Jamie Duteil is a Registered Nurse and the Health System Improvement Director at Health Quality BC. She has managed urgent primary care centres and acute care centres.
  • Kacey Wall is a Registered Nurse and a diabetes educator, she has worked in primary care networks and is a team member of the Innovation Support Unit.
  • Nikki Kafal is a Registered Nurse and has spent her career working in emergency and critical care settings. She is completing a dual master degree in nursing and health informatics and joins the Innovation Support Unit as a co-op student.

What is Team Up! Team-based primary and community care in action?

A podcast that brings together primary care providers, healthcare planners, patients, innovators and others to talk about the changes that are happening in primary care in British Columbia.

Morgan: Are you wondering how a
nurse can help with medication

management in a primary care team?

Yeah, me too.

I'm solo today.

Sarah's away, far away, on her family
adventure many time zones away.

In this episode, I wanted to
chat about how nurses can be

integral parts of medication
management in primary care teams.

So let's start with the obvious.

Kacey: We're obviously not pharmacists

Morgan: That was Kacey, a registered nurse
who has worked in primary care networks

and as a diabetes education nurse,
and she's also part of the ISU team.

Although nurses are not pharmacists,
and I've worked with both, nurses have

a lot of knowledge around medications.

Plus, they can support the related
aspects of care around the medications

at the same time as assessing
people's medication history.

Let's let Kacey continue.

Kacey: What we can do, though, is
we can sit down with patients and do

the best medical history that we can.

So we'll connect with them
and we can go through and do a

medical history, first of all.

And then using that, we can really
prompt them around the medications

that they're currently using.

and medications that they might have
used in the past that maybe, you know,

if this is a new family physician,
maybe the doctor doesn't know about.

So it's really about sitting down with
the patient, figuring out where they're

at with those pieces, also diving in
asking things about supplements, right?

We can also get access to PharmaNet to go
back and look at which medications have.

been filled.

Morgan: For those of you who are not
in British Columbia, PharmaNet is our

provincial repository for all medications
dispensed by community pharmacies.

Kacey: And then we can take that to the
doctor and And then the doctor can ask

those clarifying questions if needed.

So that's, a really good
use of, nursing in a clinic.

Morgan: So one way nurses can
engage is through taking a

medication history and collecting
information with clinical context.

This can be very helpful, especially
during transitions of care,

like discharge from hospital, or
after seeing a specialist who's

changed a bunch of medications.

Those are great times for a nurse
to jump in and do a bit more of

a thorough medication history
than I might be able to do.

And nurses can go further than just
a medication history, of course.

They can assess the impact of medications,
and that's very much in their scope.

I asked Hannah, another registered
nurse, who I get to work with every

Thursday, about medication renewals,
and she saw that Relatively simple

activity as a time to focus on treatment
goals and checking blood work status,

so not just the medication renewal.

Hannah: So someone's, up for their
medication, you know, a nurse can go

through and say, check once the last time
this person had a hemoglobin A1c or their

metabolic blood work, you know, if it's
been over six months, They're due for that

Morgan: So a nurse would dive
deeper into the assessment, perhaps

even drawing blood right then and
there, so you're all one step ahead.

Another thing that nurses can do
related to medications is that they

can advocate for patients in the team.

sometimes patients might hide that
they're not taking a medication

or they might hide the reason
why they can't take a medication.

Patients sometimes don't want
to disappoint their doctor

or their nurse practitioner.

I've seen this particularly
with, you know, financial

reasons and things like that.

Understanding a patient's barriers to
treatment and advocating for the patient

is where Jamie from HQBC went when we were
talking about medication history taking.

Jamie: if a patient comes in and the
nurse sees the patient first and they

do an assessment and they notice their
blood pressure is high, they review

the meds and they can connect with
the patient just from a, you know,

I notice it's high, like maybe it's
because you're here and you're nervous.

maybe you haven't been taking your meds
or maybe you haven't been exercising like

normal or maybe you have extra stress.

Like they can really like talk to
the patient on the patient's level.

and build that trust from the very
beginning and just understand it's not

place judgment or to, be angry by any
means, but it's just breaking down that

fear that the patient has of disclosing.

that maybe they haven't been compliant
or financially they're having challenges

paying for their meds and so maybe there's
something we can do to support that there

could be a whole host of other reasons
why, why their blood pressure is a bit

high, but it's just really digging into
the why, and then how can we address it?

And then sharing that and communicating
that with the physician so that

the patient doesn't feel that they
have to be the one to say, yeah, I

haven't been taking my for X reason.

It's really coming at that supportive
lens of communicating to the

physician what, what you've assessed.

And what your recommendations are.

Morgan: Patients might share
challenges with their nurse.

That they might not share with
their doctor or nurse practitioner,

and then the nurse can advocate on
their behalf, getting better care.

That's huge for a patient's treatment.

And whenever that's happened for me, I'm
always thankful because I don't want

to prescribe something for a patient,
that they can't afford or there's a

side effect and they don't take it.

They're not getting the benefit.

I would much prefer to know that.

And when a patient doesn't feel
comfortable sharing that, but they

can share it with their with and
through a nurse can make a huge

difference to somebody's care.

I've put this one last as an idea
because I think this is the one

that people think about the most,
and that's education around how to

take medications and side effects.

Nurses are absolutely great at this
and helping to educate patients

around specific medications.

As a diabetes educator, Kacey
was all over this, of course.

Kacey: The other thing we can do
with medications is we can also

provide education around what those
medications are being used for.

So again, in, the case of trying to
free up capacity for the doctor, is the

nurse can actually sit down similar,
but not the same, as a pharmacist and

talk to the patient about, hey, the
doctor has prescribed you insulin.

Why?

What for?

What do I need to look at?

What are the possible side effects?

So we can really be that, that
bookend of that medication so that

they, they have a really good sense
of, what they're taking and why.

Morgan: Education once a medication
is prescribed can be absolutely

super helpful, but also don't
forget about education that can

happen in follow up as well.

A phone check in to see if there
are questions a week or later after

people have started a medication.

This can be a really effective role for
nurses to bring into a team and a great

way of being proactive with some patients.

You can understand what they're What some
of the questions are several days after

starting what some of the side effects
might be what some of the challenges

might be around taking the medication,
all that can be woven into that follow up.

So I think it's a great example
of bringing education into that

conversation post prescription.

In this brief team bit, we covered
several ideas related to medication

management and where nurses have
highlighted where they can add value.

If you're a new nurse in a primary
care team, discuss some of these ideas

together as a team and decide at a
team huddle which patients you could

meet before their scheduled visit.

So you can take a broader medication
history with that patient.

Maybe it's somebody who's recently
come out of hospital or somebody

who's recently seen a specialist.

You could assess the effectiveness
of the medications around

different chronic conditions like
high blood pressure, diabetes.

There's a bunch of different ways
you could integrate a nurse into

a medication review early, and
that's a great way to start to build

those relationships with patients.

So that's all for this episode.

I hope you enjoyed it.

Thanks for listening to Team Up, and if
you do have specific questions or topic

suggestions for episodes like this,
please email us at isu at familymed.

ubc.

ca.

Sarah: The Innovation Support Unit is
a distributed multidisciplinary team.

We work mostly remotely from communities
across the Lower Mainland and

Vancouver Island in British Columbia.

Morgan: Sarah and I are both recording
from our offices in the territories

of the Lekwungen speaking peoples, the
Songhees and Esquimalt First Nations.

Sarah: And recognizing the colonial
history and the ongoing impacts of

colonization and healthcare systems
and in Indigenous communities in

Canada and around the world, as we
move through the season, we'll work

to bring an equity lens to this work.

And we really encourage you, our
listener, to reflect on your past,

present, and future participation.

On the indigenous lands
where you are situated.

Morgan: we'll see you in
the next episode of team up.