Medication history
Poonam Pant
M.Pharm
Outline
Information Sources
Challenges with difficult clients
Questions to Ask
Tips for Performing Medication History
Client Education
Tools
Reconciliation and documentation
Introduction
• The medication history of a patient is the basis on which
many further decisions are made.
• It is imperative that this is as accurate and complete as
possible.
• Often medication histories contain incorrect or incomplete
doses, and incorrect or omitted medicines.
Information Sources
• Patient
• Family or Caregiver
• Medication Vials / Bubble packs/ blister packs
• Medication List
• Community Pharmacy
• Medication Profile from other facility
• DIN (Drug Information Network)
Process
• Repeat prescription list.
• Interview with patient or career.
• Community Pharmacy Patient Medication Record (PMR) if any.
• Hospital discharge letter/summary.
• Admission letter.
• Nursing/care home Medication Record Charts.
• Medication record cards.
• Lists of medicines prepared by patients or careers.
Note: Each of these sources has it’s own limitations and therefore
in many cases a collaboration of more than one source is needed
to fully determine a patient’s accurate and complete medication
history.
Challenges with difficult clients
• Belief – physician has information
• Unfamiliar with medications and names
• Difficulty recalling
• Medicated clients (sedated, confused)
• Language barrier
• Hearing impairment
• Disease affects mental status
• Elderly clients
• Medication vials or list unavailable
When difficult in remembering…..
• If patient can not remember a medication or if clarification is
needed:
Get a description of the medication from the patient or
family member (form, strength, size, shape, color, markings)
Contact family member that could possibly bring in the
medication or read it over the phone
Call the patient’s pharmacy
Contact the specialist’s office or other physician to get an
accurate list of medications
Obtain previous medical records
Interviewing the client
• Introduce yourself
• Inform client of reason for you being there
• Inform client of importance of maintaining a current
medication list in chart
Questions to ask
Which community pharmacy do you use?
Any allergies to medications and what was the reaction?
Which medications are you currently taking:
• The name of the medication
• The dosage form
• The amount (specifically the dose)
• How are they taking it (by which route)
• How many times a day
• Any specific times
• For what reason (if not known or obvious)
Questions to ask
• What prescription medications are you taking on a regular or
as needed basis?
• What over-the-counter (non-prescription) medications are
you taking on a regular or as needed basis?
• What herbal or natural medicines are you taking on a regular
or as needed basis?
• What vitamins or other supplements are you taking?
Medication History Taking TIPS
• Balance open-ended questions (what, why, when, whom,
where, how) with yes/no questions
• Ask non-biased questions (Eg. Alendronate must be taken on
an empty stomach first thing in the morning and you must
remain upright for 30 minutes. That is how you are taking
it, right?)
• Avoid leading questions
• Explore non-compliance
• Avoid medical jargon – Keep it simple
• Avoid judgmental comments
• Various approaches can be used:
–24 hours survey (morning, lunch, supper, bedtime)
–Review of Systems (head to toe review)
–Link to prescribers (family, physician, specialists)
Medication History Taking TIPS
If medication vials available:
• Review each medication vials with patient
• Confirm content of bottle
• Confirm instructions on prescription vials are current
If medication list available:
• Review each medication with patient
• Confirm that it is current
If bubble packs available:
• Review each medication with patient
• Confirm patient is taking entire contents
Other Questions
• Have you recently started any new medications?
• Did a doctor change the dose or stop any of your medications
recently?
• Did you change the dose or stopped any of your medications
recently?
Additional Questions to Explore
Effectiveness/Compliance
• Are any of the medications causing side effects?
• Have you changed the dose or stopped any medications
because of unwanted effects?
• Do you sometimes stop taking your medicine whenever you
feel better?
• Do you sometimes stop taking your medicine if it makes you
feel worse?
Reconciliation & Documentation
• Upon discovering a discrepancy
– Update the list if minor (eg OTC)
– Include medications prescribed by other physicians (eg
specialist)
– Inform physician if client is not taking as prescribed
• Document in the client’s chart
– The date MedRec completed and initial on the medication
status record
– Any relevant information in the progress notes
• Preparation of needed prescriptions
Client Education
• Encourage ownership
• Educate client to bring medications from home at each
appointment
• Educate client to carry a list of current medications
(prescription and OTC)
• Encourage family members/ caregivers to become involved
• Encourage one pharmacy
My name is: _________________________________________________
My pharmacy is: ______________________________________________
I am allergic to: _______________________________________________
The medications that I can’t take because I have had side effects are: (please describe the side effect)
________________________________________________________________________
________________________________________________________________________
My current medications include:
Name of medication Why do you What does What is the How often do you When did you start
take it? the dose? take it? taking it?
medication
look like?
Assignment
• Take a medication history of a patient and present with your
inference?
• Patient detail
• Case
• Medication history
• Current medication
• Comment from clinical pharmacist
Thank you
