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

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)

 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

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

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

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, www.canada411.ca proximity search (with street names)

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

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

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 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

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

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)

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)

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

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

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

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

Questions olavo.fernandes@uhn.on.ca