Taking Medication Histories EMTENAN ALHARBI ,Msc Clinical Pharmacy Department

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

Medication history.. Importance Med Hx starting point for clinician to identify the patient’s understanding of The role of medications in the treatment of disease Patient’s compliance Medication’s effectiveness Side effects, allergy

Why pharmacists? Unique combination of drug related expertise and experience; Patient trust and respect pharmacists

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

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

What are the sources for patient information?

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

Steps for successful Medical History Session Preparation Observation of patient and his environment Before the Interview Data to be collected Communication skills During the Interview Documentation of the Med Hx After the Interview

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

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

Data Collection What type of information is included during a medication history session? PHCL 326: communication skills for Pharmacists 4/6/2017

Data to be Collected Demographic Information Dietary Information Social Habits Current & Pat Rx medications Current & Past OTC medication Current & Past alternative remedies Allergies Adverse drug reactions Compliance assessment

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

Dietary Information Restrictions Supplements Stimulants suppressants

Social Habits Tobacco: Alcohol: Illicit drugs 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

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)

2x5= 10 pk-yr smoking history. 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.

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

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

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

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

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

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

Immunization Vaccines Date of administration

Compliance Assessment 10/07/1438 Compliance Assessment Causes of non-compliance ADR Cost Unavailability Inappropriate dosage form Not understanding the reason for taking the medication Deliberate /gab

Questioning Techniques Open-ended questions Close-ended questions Targeted questions Leading questions

Setting the stage for the interview

Pay attention to communication skills

Avoid Hindering Behaviors

10/07/1438 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 /gab

Documentation Standardized Freestyle SOAP

4/6/2017

PHCL 326: communication skills for Pharmacists 4/6/2017

PHCL 326: communication skills for Pharmacists 4/6/2017

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