1. The 30 Minute BPMH Work Out: Tips, Tools and Strategies for Getting an Efficient and Complete Best Possible Medication History
Olavo Fernandes BScPhm, ACPR, PharmD, FCSHP
Consultant, ISMP Canada
Assistant Professor and Pharmacy Clinical Site Leader
University Health Network/ Univ. of Toronto
Improving Resident Safety with Medication Reconciliation Conference
Moncton, September 2008
Handout Version

2. Objectives
Summarize key frontline challenges to obtaining an accurate & efficient BPMH
Characteristics of common areas of improvement
Outline selected strategic solutions to overcome barriers to obtaining a BPMH
Highlight practical tips & tools to support clinicians in obtaining the “golden” BPMH
Highlight useful tools/forms on the Safer Health Care Now! Community of Practice (CoP)

3.  WHO HAS THE BEST MED LIST ? Patient Interview Labels on Rx Vials
Medication Lists
Family MD
Patient’s Actual Medication Use
Medical chart
Medication wallet cards
Community pharmacist
Patient’s Medication Regimen Prescribed
WHO HAS THE BEST MED LIST ? 
What is the “truth”?
Y. Kwan BScPhm

4. What is a Best Possible Medication History ?
A medication history obtained by a clinician which includes a thorough history of regular medication use (prescription and nonprescription)
Uses information from: physician, patient or caregiver interview, inspection of prescription vials, community pharmacy follow-up, or current med list printed by community pharmacy
What about a just a “quality” patient interview?
Jacqueline Wong BScPhm

5. Patient Factor Challenges
Communication barriers
Non – English speaking patients
Level of consciousness/ cognitive impairment – post op/ acutely ill
Solution: family members, interpreters, community pharmacy, BPMH prior to OR whenever possible
Patient understanding of need to obtain an accurate medication history
Solution: proactively explain importance, empower patient to actively participate

6. Patient Factor Challenges
Poor perception of what is a medication?
Patients may not commonly list : OTCs, herbals, vitamins, non-traditional , street drugs
Solution: effective prompting/ follow/ up questions
Poor Patient recall – complete list of medications or pharmacy name/ number:
Solution: contact community pharmacy, proximity search (with street names)

7. System & Process Challenges
Time/ Resources needed for a BPMH
Solution: Active Preparation: review other sources/ primary medication histories prior to interview to streamline process/ anticipate discrepancies
Medication Use  Medication prescribed
Solution: Focus on “medication use”
Solution: Seek clarification : community pharmacy, primary care physicians, family

8. System & Process Challenges
Accessibility - patients may not bring in medication vials/ lists to hospital
Solution: Reminder prior to clinic visits; family ; contact community pharmacy
Complexity of obtaining a comprehensive, accurate history
Solution: anticipate skills required
Interviewing skills, knowledge base

9. 10 Practical Tips Obtaining a reliable and accurate medication history
Prompt questions about unique dosage forms: eye drops , creams, inhalers, patches, sprays
Prompt questions about OTCs/ Vitamins / Herbals/ Non-traditional remedies
Example: Patient may not recall ASA
Inquire about changes from medication vials: dose changes/ stopped medications (patient or MD initiated)

10. 10 Practical Tips Obtaining a reliable and accurate medication history
Use medical conditions listed as a trigger
Assessing patient adherence/ compliance
Inspect vials (? recently filled, be cautious of different contents)
Community pharmacy /contacts- anticipate/inquire about multiple pharmacies

11. 10 Practical Tips Obtaining a reliable and accurate medication history
Verifying accuracy –try to validate with at least 2 sources of information where possible
(patient history, vials, community pharmacy)
Be Proactive:
Gather as much information as possible before seeing the client (primary histories, provincial database info, info from previous admissions)
Readily accessible resources for consultation

12. 10 Practical Tips Obtaining a reliable and accurate medication history
Don’t assume patient is taking medications according to prescription vial label
Open ended questions on medication use (how do you take this?)
Inquire about why taking differently - ? Side effects ? Efficacy
Use a BPMH trigger sheet !! ( or another tool to guide a systematic process)

13. Medication History: Information Sources include…..
Provincial drug data base
Patient interviews
MD chart notes
Standardized forms
Primary care physician records
Inspection of Medication vials
Review of community pharmacy records
Review of hospital records (previous admissions)

14. Implementing Your Own Clinician Validation Program
Part A: Interactive Learning/ Education Session
Part B: Pre or Post Reading
SHN! LTC Getting Started Kit
Part C: Standardized Patient Validation Program

15. Sample: Interactive Learning/ Education Session
Patient Impact of Medication Discrepancies
Introduction to Medication Reconciliation
Conducting an Effective BPMH
Admission Reconciliation
Identifying & Coding Discrepancies

16. Implementing Your Own Clinician Validation Program
Standardized Patient Validation Program
Part I: Obtain BPMH from a standardized patient – actor (clinician provided feedback on process)
Props including: vials/ lists
Feedback/ Score on accuracy- score sheet
Feedback/ Score on process- score sheet
Part II: admission reconciliation to identify discrepancies
Part III: admission reconciliation coding of discrepancies
Part IV: Feedback: Interactive discussion on areas of strength / improvement

17. Tools & Strategies on CoP
BPMH guides/ trigger sheets
BPMH Forms
BPMH leading to admission order forms
Instructional Videos
Empowering patients as part of the BPMH process

18. Questions