The ABCs of Medication Management

Supply Management Patient Safety

By: Natalie Hope McDonald | OSM Contributor

Published: 9/24/2025

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An interview with pharmacy and safe medication management consultant Sheldon S. Sones.

Sheldon S. Sones, RPh, FASCP, is president and founder of Sheldon Sones and Associates. Based in Connecticut, the company has provided more than 200 surgical facilities in the Northeast U.S. with pharmacy and safe medication management consultation since 1985. Mr. Sones recently shared his thoughts with Outpatient Surgery Magazine on the importance of medication management and some problems that can occur when providers and patients don’t communicate effectively, with the goal of reinforcing best practices and improving the patient experience in outpatient surgical settings.

Why is medication management so important for outpatient surgery?
It’s all about standards and best practices for the transition of care. It’s a four-legged stool: medicine reconciliation on admission, medicine management intraprocedure, medicine management post-procedure and clear guidance on discharge. If one leg is not there, things can get wobbly.

There’s also the issue of patient medical comprehension, language barriers, complexity of instructions and perhaps even the absence of a responsible party to learn the guidance and retention of advice in a post-procedure climate. All of these are potentially problematic and can result in unintended consequences in an otherwise positive experience.

Can you give me an example?
I have witnessed poor guidance on blood thinners post-surgery and multiple ophthalmics in cataract surgeries. The bottom line is that good guidance, with documented instructions, is a holistic strategy that should be mandatory. Facilities can be party to the problem if this element of performance is not in good stead. Enhanced patient recovery is the goal, strongly supported by AORN.

What are some of the biggest risks patients face if they don’t complete or adhere to a medication plan when they are sent home from surgery?
The risks can be catastrophic. Think of starting blood thinners too soon, or even the failure to advise regarding NSAID avoidance. Think of poor antibiotic stewardship. Think of ophthalmic noncompliance. Think of so many other scenarios where guidance on the medication plan is misunderstood or not adhered to. Think poorly controlled drug management. It needs to be a holistic approach that addresses any potential side effects or impediments to patient recovery.

What are some of the most effective ways a surgery center can help facilitate the best possible adherence to a medication or pain management plan?
Clear written instructions with an eye toward language barriers is important. Also advocate for a responsible party to be part of the guidance. Follow up with phone calls to check in on patients about their post-procedure statuses. Answer any questions the patient may have and validate that they understand the overall medication awareness and compliance needed for their recovery.

BEST PRACTICES
Patient Education’s Role in Medication Management

Do you know that half of all patients who are prescribed medication don’t always take it properly? Do you also know that approximately one in five new prescriptions in the U.S. are never even filled?

It’s been proven that adherence to medication guidelines has an overwhelmingly positive impact on a patient’s immediate and long-term health, but prioritizing that adherence can sometimes fall through the cracks for healthcare providers.

The results of this disinterest in adherence to guidelines among providers and their patients are devastating. In fact, according to the National Institutes of Health, as many as 125,000 deaths can be prevented each year through adherence to proper medication management.

Ultimately, widespread breakdowns in proper medication management are costing the U.S. healthcare system as much as $300 billion every year in preventable hospitalizations, ER visits and additional appointments.

The impact on surgery

The world of surgery is a big part of that equation, so it’s always a good time to refresh your facility’s medication management protocols and practices.

When it comes to preoperative, intraoperative and postoperative medication management, it is critical to minimize complications and optimize the anesthetic and analgesic effects of medications that are administered perioperatively.

It’s also important to individualize management of medications. For example, in the pre-op period, certain medications can increase risk of surgical complications such as bleeding, blood clots, adverse reactions to anesthesia and other impacts. Some common diabetes medications, for example, can delay stomach emptying and risk regurgitation during surgery.

Careful medication management throughout the surgical episode can minimize or eliminate issues such as postoperative delirium, respiratory depression and venous thromboembolism. Perhaps most importantly, it can ensure each of your patients a much smoother transition at home to enable the best possible recovery and outcome.

Realities and strategies

Medication management really is a team effort. For the medications you administer or prescribe to be as effective as possible, patients need to be educated about them, and doctors and staff should ensure they have all the information the patients need to follow through with proper dosing.

An educated patient who understands the importance and risks of their medication regimen has a better chance of being a compliant patient. Consider that, according to the CDC, patients don’t take their medications for a variety of reasons, including forgetfulness (as many as 40% of patients admit they forget to take their medications), an inability to renew their prescriptions on time, or simply not being able to afford the cost of the drugs.

Surgical providers need to get ahead of those issues because the consequences can be highly negative. Poor medication adherence is linked to up to 69% of medication-related hospital admissions and can often lead to prolonged and costly inpatient hospital stays that should — and can — be avoided.

Some effective strategies for better medication management include identifying your most at-risk patients and simplifying how they can maintain a proper dosing schedule.

Public health initiatives can help to reduce economic and other burdens that can make getting and paying for medications an issue for many patients. There are programs available from state governments and pharmaceutical companies that can help alleviate the high costs of some newer medications.

Tips for improving medication management

Here are several proven strategies to improve medication management and adherence:

• Patient education is mission-critical. Provide clear and concise information about each medication, including what it’s used for, how it needs to be taken, any potential side effects and why, above all, it can help the patient.

• Build an open and honest relationship with patients. Encourage them to ask about the medications they are taking and help them address any challenges they may be having. Sometimes it’s as simple as adjusting a medication because of problematic side effects. Create a blame-free, helpful environment where patients feel comfortable discussing any of their medication challenges.

• Simplify medication plans whenever possible. Ideally, you should prescribe medications that can be taken once or twice a day or in combination with other meds to reduce the number of daily doses. Review the medications the patient is taking to consider if any can be eliminated, while also ensuring there are no harmful interactions.

• Use technology to prescribe and automate the dispensing and use of medications. Smartphone apps and pill boxes can effectively remind patients to take their medications. It’s helpful, when possible, to encourage patients to reach out to friends and family if they’re having trouble with an app or have questions about dosages.

• Encourage pharmacists to be more involved in the process. They can provide valuable information about medication and help monitor adherence based on refill schedules.

• Address any barriers for patients in getting their prescribed medications. Discuss the costs with the patient and provide information about financial assistance and lower-cost options. Follow up to ensure patients understand their options and that they can access the medications they need in a timely matter.

— Natalie Hope McDonald

How can a facility know if it is doing the best job possible in explaining pre- and post-surgery medication management to patients?
I can think of one example that we do: a tally in our facilities. For example, poor prep can lead to canceled cases in colonoscopy procedures. This cascades to having significant patient impact, schedule disruption and increased costs, and also points to a lack of patient understanding and inadequate pre-procedure instructions. I can also point to anticoagulant/platelet aggregation mismanagement, as well as food abstinence failures.

Sones


How does following a plan mitigate these issues?
Following the medication plans and pre-procedure instructions minimizes risk, stages better outcomes and enables favorable facility management.

When it comes to minimizing these issues on the clinical side, specific to, for example, allergies or side effects of medications, what are some important considerations when speaking to a patient?
This is a really important question, and my own observations place this high on the to-do list. For example, making the distinction between an allergy to a medication and its side effects is one way. Patients do not always recognize the difference.

A simple example would be a patient who claims an “allergy” to cephalosporins because of diarrhea with cephalexin. The surgeon may request a cephazolin IV during pre-op. Or maybe a patient has had an anaphylactic reaction to previous oral cephalosporins. The prescriber needs to evaluate the declared allergies and degree of sensitivity, assuring that drugs of choice are not avoided without reasonable cause.

What are some ways doctors can avoid prescribing opioids to patients who have a history of addiction?
With a known history of addiction, one pathway should be followed: choices of alternative drugs are available. And states have guidelines for prescriptive practices of opioids that limit quantities and prohibit unauthorized refills. Prescriber registration and audit mechanisms are also in place.

How is AI and other technology being used to help monitor patients postoperatively?
I think the point is, “How can they be used well?” It’s still evolving. Health systems nationwide have enabled really great progress in a continuum of providing information that is easy to access. It’s getting better and better. The monitoring part will require patient participation in real time with feedback, which of course will depend on computer aptitude and patient interest in pursuing and participating in the process. OSM

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