Case Study: Clinical Round Table

A 49-year-old female is being treated for a five year injury. The injured worker had surgery on 4/10/2019. She is treated at various clinics and sees different providers including her primary care physician and surgeon. Medications prescribed prior to roundtable discussion on May 28, 2019 include:

• Cyclobenzaprine 10 mg 2x day
• Meloxicam 15 mg 1x day
• Diclofenac 1% gel
• Hydrocodone/Acetaminophen 5/325 #5/day
• Ondansetron 8 mg #3/day
• Tramadol 50 mg 5X day
• Ketorolac 10 mg #4/day x 3 days
• Gabapentin 100 mg 3x day
• Duloxetine 60 mg 1x day

Roundtable was scheduled to discuss the clinical escalation for polypharmacy (use of seven or more medications in 30 days); four different prescribers, duplication of therapy, treating for potential adverse drug reactions.

Diclofenac gel/Meloxicam/ Ketorolac therapeutic overlap and should not be taken together. Ondansetron is prescribed, which is anti-nausea medication for cancer or post-surgical; also suspect possible GI upset from multiple NSAIDs. Tramadol dose exceeds the maximum; duplicate opioids with hydrocodone. The team referred the case for Pharmacy review and Peer-to-Peer with PCP and surgeon.

The team was successful in reducing multiple prescribers to a single prescriber, and from nine medications down to three prescribed since November 2019 at lower dosages:

• Cyclobenzaprine 10 mg 1x day
• Meloxicam 7.5 mg 1x day
• Diclofenac gel 1% 100 gm/25 days