Ten Practical Tips for a Best Possible Medication History

Wenya Miao, BScPhm, PharmD, ACPR and Chris Fan-Lun (BScPhm, ACPR, BCGP

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

  1. Be proactive. Gather as much information as possible prior to seeing the patient. Include primary medication histories, provincial database information, and medications vials/ lists.
  2. Prompt questions about non-prescription categories: over the counter drugs, vitamins, recreational drugs, herbal/traditional remedies.
  3. Prompt questions about unique dosage forms: eye drops, inhalers, patches, and sprays.
  4. Don’t assume patients are taking medications according to prescription vials.  Ask about recent changes initiated by either the patient or the prescriber.
  5. Use open-ended questions: “Tell me how you take this medication?”
  6. Use medical conditions as a trigger to prompt consideration of appropriate common medications:  “When you get short of breath, what medications do you take?”
  7. Consider patient adherence with prescribed regimens:  “Has the medication been recently filled?”
  8. Verify accuracy: validate with at least two sources of information.
  9. Obtain community pharmacy contact information: anticipate and inquire about multiple pharmacies.
  10. 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?

Medication Allergies

  • Do you have any medication allergies? If yes, what happens when you take__ _?

Information Gathering

  • 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?

Community Pharmacy

  • 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 ________?

Vitamins/Minerals/Supplements

  • 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 __ ?

Eye/Ear/Nose Drops

  • 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?

Inhalers /Patches/Creams/Ointments/Injectables/Samples

  • 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?

Antibiotics

  • Have you used any antibiotics in the past 3 months?

Closing

  • 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.

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