Ten Practical Tips for a Best Possible Medication History
This article was reproduced with permission from the authors.
Original article from geriatric-ed.com.
Wenya Miao (BScPhm, PharmD, ACPR) and Chris Fan-Lun (BScPhm, ACPR, BCGP) , pharmacists at Mount Sinai Hospital in Toronto share how to obtain a Best Possible Medication History (BPMH) in the ED, and provide an example BPMH script to follow.
10 Practical Tips
- Be proactive. Gather as much information as possible prior to seeing the patient. Include primary medication histories, provincial database information, and medications vials/ lists.
- Prompt questions about non-prescription categories: over the counter drugs, vitamins, recreational drugs, herbal/traditional remedies.
- Prompt questions about unique dosage forms: eye drops, inhalers, patches, and sprays.
- Don’t assume patients are taking medications according to prescription vials. Ask about recent changes initiated by either the patient or the prescriber.
- Use open-ended questions: “Tell me how you take this medication?”
- Use medical conditions as a trigger to prompt consideration of appropriate common medications: “When you get short of breath, what medications do you take?”
- Consider patient adherence with prescribed regimens: “Has the medication been recently filled?”
- Verify accuracy: validate with at least two sources of information.
- Obtain community pharmacy contact information: anticipate and inquire about multiple pharmacies.
- Use a BPMH trigger sheet or a systematic process /interview guide like the one found here. Include efficient order/optimal phrasing of questions and prompts for commonly missed medications
Best Possible Medication History (BPMH) Guide
Here is an outline for a script that any health care provider can use in the ED to ensure an accurate medication history — before discharge or before admission:
Introduction – Introduce self and profession
- I would like to take some time to review the medications you take at home.
- I have a list of medications from your chart/file, and want to make sure it is accurate and up to date.
- Would it be possible to discuss your medications with you (or a family member) at this time?
- Do you have any medication allergies? If yes, what happens when you take__ _?
- Do you have your medication list or pill bottles (vials) with you?
- Show and tell technique when they have brought the medication vials with them.
- How do you take (medication name)?
- How often or when do you take (medication name)?
- Collect information about dose, route and frequency for each drug. If the patient is taking a medication differently than prescribed, record what the patient is actually taking and note the discrepancy.
- Are there any prescription medications you (or your physician) have recently stopped or changed?
- What was the reason for this change?
- What is the name of the pharmacy that you normally go to? (Name/Location: anticipate more than one)
- May we call your pharmacy to clarify your medications if needed?
Over the Counter (OTCs) Medications
- Are there any medications that you are taking that you do not need a prescription for? (Do you take anything that you would buy without a doctorʼs prescription?) Give example, e.g. Aspirin. If yes, how do you take ________?
- Do you take any vitamins (e.g. multivitamin)? If yes, how do you take __?
- Do you take any minerals (e.g. calcium, iron)? If yes, how do you take __?
- Do you use any supplements (e.g. glucosamine, St. Johnʼs Wort)? If yes, how do you take them __ ?
- Do you use any eye drops? If yes, what are the names and how many drops do you use and how often? In which eye?
- Do you use any ear or nose drops/nose sprays? If yes, how do you use them?
- Do you use any inhalers? any medicated patches? medicated creams or ointments? any injectable medications (e.g. insulin)? For each, if yes, how do you take ___? (name, strength, how often)
- Did your doctor give you any medication samples to try in the last few months?
- Have you used any antibiotics in the past 3 months?
- This concludes our interview. Thank you for your time. Do you have any questions?
- If you remember anything after our discussion please contact me to update the information?
Exit room and wash hands. Proceed to document interaction in chart/file.