Taking Medication Histories

1. Taking Medication Histories EMTENAN ALHARBI ,Msc Clinical Pharmacy Department

2. Learning Objectives • Importance of medication history by pharmacist • State the advantages & disadvantages of interviewing patients before and after review of patient information • Identify the most relevant information from observing patient surroundings • List the categories of data to be collected during the interview • Describe the type of information under each category • Differentiate between allergy and ADR. • State how to assess patient compliance. • Identify types of questions to use and to avoid. • Discuss the different type of documentation styles

3. Medication history.. Importance

4. Why pharmacists?

5. Errors attributed to incomplete Medication History • Errors of omission • Errors of commission • Incorrect dose • Incorrect frequency • Incorrect strength • Incorrect name • Incorrect dosage form

6. Medication Reconciliation • The process of comparing the patient’s preadmission medications with the medications prescribed during the hospitalization • Intended to prevent medication-related problems such as duplication, interaction.. • Successful medication reconciliation depends on obtaining an accurate and complete medication history

7. What are the sources for patient information?

8. Sources of Information for patient database • Patient encounter • Patient interview: The patient is typically the primary source of medical information. • Physical assessment of the patient • Caregiver/family member • Healthcare professional caring for the patient • Medical chart

9. Steps for successful Medical History Session

10. Preparation.. Review the patient‘s information • Review patient profile then conduct the interview • Setting: hospitalized, nursing home patients • Advantage: • Prior knowledge, better preparation • More comfortable • Disadvantage: • Important information can be overlooked. • Interview patient with no background knowledge • Setting: community pharmacy • Advantage: • Unbiased • Allow for exploration of all aspects equally • Disadvantage: • Intimidating • Time consuming

11. Preparation.. Observe Patient and his Surrounding • Patient state of health • Socioeconomic status • e.g. Cost of med. • Compliance with dietary recommendations • e.g. Antihypertensive agent & salt restriction • Social support system

12. Data Collection What type of information is included during a medication history session? PHCL 326: communication skills for Pharmacists

13. Data to be Collected

14. Demographic Information • Age/date of birth • Gender • Height and weight • Race and ethnic origin • Residence • Education • Occupation • Life style

15. Dietary Information • Restrictions • Supplements • Stimulants • suppressants

16. Social Habits • Tobacco: • Start, quit date; quantity (pack-years) • It is quantified in terms of packs per day (ppd) and expressed in pack-tears (pk-yr) • Alcohol: • Type, quantity, pattern, duration of use • Illicit drugs

17. Social Habits..Packs-Year • Number of pack years = (number of cigarettes smoked per day x number of years smoked)/20 *1 pack=20 cigarettes • Number of pack years = (number of packs smoked per day x number of years smoked)

18. Social Habits..Example • a patient who has smoked 15 cigarettes a day for 40 years has a: • A patient who smoked 2 packs per day for 5 years • (15x40)/20 = 30 pk-yr smoking history. • 2x5= 10 pk-yr smoking history.

19. Current Rx medications • Name/description • Dosage • Dosing schedule (prescribed, actual, PRN) • Indications • Date med started • Outcome of therapy

20. Past Rx medications • Name/description • Dosage • Dosing schedule (prescribed, actual, PRN) • Indications • Date med started • Date med stopped • Reason for stopping • Outcome of therapy

21. Current & Past OTC medication • Name/description • Dosage • Dosing schedule (recommended and actual) • Indications • Date med started • Date med stopped • Outcome of therapy • Reasons for stopping the med

22. Current & Past Alternative Remedies • Name/description • Dosage • Dosing schedule (prescribed and actual) • Indications • Date remedy started or stopped • Outcome of therapy • Reasons for stopping the med

23. Allergies • Name & description of causative agent • Dosage • Date of reaction • Description of reaction • How the reaction was treated

24. Adverse Drug Reactions • Name & description of causative agent • Dosage • Date of reaction • Description of reaction • How the reaction was treated

25. Immunization • Vaccines • Date of administration

26. Compliance Assessment • Causes of non-compliance • ADR • Cost • Unavailability • Inappropriate dosage form • Not understanding the reason for taking the medication • Deliberate

27. Questioning Techniques • Open-ended questions • Close-ended questions • Targeted questions • Leading questions

28. Setting the stage for the interview

29. Pay attention to communication skills

30. Avoid Hindering Behaviors

31. After the Interview • Document your medication history in patient file/chart • Make sure to: • Write eligibly (print is preferred) • Record Date & Time of the interview • Your initial and signature • Write SOAP for medication related problems indentified during the interview

32. Documentation • Standardized • Freestyle • SOAP

33. Individual Assignment • Find a relative, neighbor or a friend and obtain a medication history from • Use the standardized data collection sheet