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If you assume patients aren’t taking herbal supplements because they don’t mention it, you may be wrong. A recent study found that although 24% of patients were using complementary and alternative medicine (CAM), only 67% of users informed their health care provider about this.1
It is important to ask about CAM use because you can use that information to help guide care, such as planning discharge instructions, says Patricia M. Campbell, RN, MSN, CCRN, ANP CS, an emergency nurse practitioner at Good Samaritan Regional Medical Center in Phoenix.
Here are things to consider when screening patients for CAM use:
• Consider drug interactions.
If patients are taking herbal supplements, there could be interactions with prescription medications that you should consider, says Campbell. She points to the following potential drug/herb interactions:
— Central nervous system depressants taken with kava or valerian may produce excessive drowsiness.
— Corticosteroids taken with echinacea or astragalus may offset the immunosuppressive action of glucorticoids.
— Digoxin taken with hawthorn may potentiate digoxin.
— Monoamine oxidase inhibitors (MAOIs) taken with ginseng, ephedra, or St. John’s wort may cause a hypertensive crisis or serotonin syndrome.
Report the use of any supplement to the physician or nurse practitioner, says Sherri-Lynne Almeida, RN, MSN, MEd, DrPH, CEN, president-elect of the Des Plaines, IL-based Emergency Nurses Association and vice president of client services for Team Health Southwest in Houston. "Most nurses and practitioners are not familiar with the many supplements available and would have to research the potential for a drug interaction," she notes.
There are many herbal supplements on the market that can diminish the effects of prescription medication, adds Almeida. "This could result in a negative outcome for the patient," she says.
• Ask specific questions about CAM use.
When asking patients if they take over-the-counter medications, specifically mention herbal supplements, amino acids, and vitamins, Almeida says. "Sometimes patients need to be prompted as they do not consider these to be medications."
Campbell recommends asking patients these three questions:
1. Do you use any herbs, vitamins, food supplements, or homeopathic remedies?
2. Do you use complementary and alternative medicine, such as acupuncture, biofeedback, or mediation?
3. Are you under the care of a complementary and alternative medicine practitioner?
• Consider that symptoms may be caused by herbal supplements.
Patients may be taking food supplements or herbs that are actually causing some of the symptoms that they are presenting with, Campbell says. She gives the following example: If a patient presents with new onset hypertension or a cardiac arrhythmia, it is essential to ascertain if they are taking any herbs that may have caused this condition.
• Document your assessment.
Most emergency department (ED) forms do not include space to document CAM use, notes Almeida. "Out of the 16 hospitals I consult with, not one facility has a designated area on the nursing assessment sheet for this purpose," she says. "I don’t think that this concept has truly hit mainstream nursing yet."
Document responses to specific questions about alternative therapy use on the patient record, says Campbell. "Most ED records do not have space for this information, but it can be documented in the medication’ section," she suggests.
Document any herbs, food supplements, homeopathic remedies, or vitamins, Campbell says. "Any other complimentary therapies such as acupuncture can be documented under past medical history, along with the condition they were treating."
• Address discharge planning.
Campbell recommends including CAM therapies in your discharge planning if possible. "For example, a patient with back pain who seeks relief in the ED will usually be discharged with muscle relaxants and pain medication," she says. "If a patient is open to CAM, then a referral for acupuncture may also be appropriate."
You’ll also need to know about CAM use to ensure no problems occur after the patient leaves the ED, says Campbell. "In addition, if you discharge the patient on new medication but are unaware about the herbs they are taking at home, there could be an adverse reaction," she says.
1. Weiss SJ, Takakuwa KM, Ernst AA. Use, understanding, and beliefs about complementary and alternative medicines among emergency department patients. Acad Emerg Med 2001; 8:41-47.