Medication Adherence Review
Find out what patients are actually taking — spot non-adherence, understand why, and route problems to the provider.
Learning Objectives
- 1.Conduct a non-judgmental medication adherence review.
- 2.Identify common barriers to taking cardiac medications.
- 3.Document and escalate adherence problems appropriately.
Purpose
Cardiac medications only work if patients take them. Many don’t — and won’t admit it unless asked the right way. Surfacing real adherence is one of the highest-impact things a nurse does.
What to ask (non-judgmentally)
- •"Many people miss doses — how often does that happen for you?"
- •Which medications, and how are they actually taking them?
- •Any side effects making them stop or skip?
- •Cost, refills, or access problems?
- •Do they understand what each medicine is for?
Common barriers
- •Cost / insurance gaps.
- •Side effects (e.g., fatigue, dizziness, cough, frequent urination).
- •Complex regimens or confusion about changes.
- •Feeling "fine" and not seeing the point.
- •Ran out and didn’t refill.
What meds/labs matter
- •High-stakes meds: anticoagulants, antiplatelets, beta-blockers, diuretics, antiarrhythmics, statins.
- •Stopping anticoagulation or a beta-blocker abruptly can be dangerous — flag it.
Red flags
- •Stopped an anticoagulant/antiplatelet (clot/stroke risk).
- •Abruptly stopped a beta-blocker (rebound).
- •Out of a critical med with symptoms.
Escalate
Non-adherence to anticoagulation, antiplatelets, or beta-blockers — or any adherence gap with new symptoms — should be communicated to the provider, not just noted.
What to document & send the provider
- •Exactly what they’re taking vs. what’s prescribed.
- •The barrier (cost, side effect, confusion).
- •Any critical med stopped and when.
Patient education script
- •"Let’s go through each medicine and how you actually take it — no judgment."
- •"If a medicine is causing a problem or you can’t afford it, tell us — there are usually options. Don’t just stop."
Mini case
A post-stent patient mentions they stopped their "blood thinner" two weeks ago because it was expensive.
What now?
Show answer
This is a red flag — stopping antiplatelet therapy after a stent risks stent thrombosis. Escalate to the provider promptly, document what/when/why, and don’t just advise refilling without provider input.
Checklist
- Asked about adherence in a non-judgmental way.
- Identified the specific barrier.
- Flagged any critical med stopped.
- Documented actual vs. prescribed and escalated as needed.