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TAKING MEDICATION HISTORIES EMTENAN ALHARBI,Msc Clinical Pharmacy Department.

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Presentation on theme: "TAKING MEDICATION HISTORIES EMTENAN ALHARBI,Msc Clinical Pharmacy Department."— Presentation transcript:

1 TAKING MEDICATION HISTORIES EMTENAN ALHARBI,Msc Clinical Pharmacy Department

2 Learning Objectives 1. Importance of medication history by pharmacist 2. State the advantages & disadvantages of interviewing patients before and after review of patient information 3. Identify the most relevant information from observing patient surroundings 4. List the categories of data to be collected during the interview 5. Describe the type of information under each category 6. Differentiate between allergy and ADR. 7. State how to assess patient compliance. 8. Identify types of questions to use and to avoid. 9. Discuss the different type of documentation styles 2

3 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

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

5 Errors attributed to incomplete Medication History 5  Errors of omission  Errors of commission  Incorrect dose  Incorrect frequency  Incorrect strength  Incorrect name  Incorrect dosage form

6 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

7 What are the sources for patient information? 7

8 Sources of Information for patient database 8  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

9 Steps for successful Medical History Session 9 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

10 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.  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  Interview patient with no background knowledge  Setting: community pharmacy  Advantage:  Unbiased  Allow for exploration of all aspects equally  Disadvantage:  Intimidating  Time consuming 10

11 Preparation.. Observe Patient and his Surrounding 11  Patient state of health  Socioeconomic status  e.g. Cost of med.  Compliance with dietary recommendations  e.g. Antihypertensive agent & salt restriction  Social support system

12 What type of information is included during a medication history session? Data Collection 10/10/ PHCL 326: communication skills for Pharmacists

13 Data to be Collected 13 Demographic Information Dietary Information Social Habits Current & Pat Rx medications Current & Past OTC medication Current & Past alternative remedies Allergies Adverse drug reactions Compliance assessment

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

15 Dietary Information 15  Restrictions  Supplements  Stimulants  suppressants

16 Social Habits 16  Tobacco:  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

17 Social Habits..Packs-Year 17  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)

18 Social Habits..Example 18  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.

19 Current Rx medications 19  Name/description  Dosage  Dosing schedule (prescribed, actual, PRN)  Indications  Date med started  Outcome of therapy

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

21 Current & Past OTC medication 21  Name/description  Dosage  Dosing schedule (recommended and actual)  Indications  Date med started  Date med stopped  Outcome of therapy  Reasons for stopping the med

22 Current & Past Alternative Remedies 22  Name/description  Dosage  Dosing schedule (prescribed and actual)  Indications  Date remedy started or stopped  Outcome of therapy  Reasons for stopping the med

23 Allergies 23  Name & description of causative agent  Dosage  Date of reaction  Description of reaction  How the reaction was treated

24 Adverse Drug Reactions 24  Name & description of causative agent  Dosage  Date of reaction  Description of reaction  How the reaction was treated

25 Immunization  Vaccines  Date of administration

26 Compliance Assessment 26  Causes of non-compliance  ADR  Cost  Unavailability  Inappropriate dosage form  Not understanding the reason for taking the medication Deliberate

27 Questioning Techniques 27  Open-ended questions  Close-ended questions  Targeted questions  Leading questions

28 Setting the stage for the interview 28

29 Pay attention to communication skills 29

30 Avoid Hindering Behaviors 30

31 After the Interview 31  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

32 Documentation 32  Standardized Standardized  Freestyle Freestyle  SOAP SOAP

33 10/10/

34 10/10/2014PHCL 326: communication skills for Pharmacists 34

35 10/10/2014PHCL 326: communication skills for Pharmacists 35

36 Individual Assignment 36  Find a relative, neighbor or a friend and obtain a medication history from  Use the standardized data collection sheet


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