MEDICATION HISTORY INTERVIEW

**Medication history** is a comprehensive record of all medications that a patient has taken, including prescription drugs, over-the-counter (OTC) medications, herbal supplements, vitamins, and other alternative therapies. This detailed history includes various elements:

1. **Drug Names**: The exact names of all medications, including generic and brand names.
2. **Dosages**: The amount of each medication taken at one time.
3. **Routes of Administration**: How the medication is taken, such as orally, intravenously, topically, etc.
4. **Frequency**: How often the medication is taken, such as daily, twice a day, weekly, etc.
5. **Duration of Use**: The length of time the medication has been or was being taken.
6. **Indications**: The reasons or medical conditions for which each medication was prescribed or taken.
7. **Start and Stop Dates**: When the medication was started and, if applicable, when it was discontinued.
8. **Prescribing Physicians**: The healthcare providers who prescribed each medication.
9. **Adverse Reactions and Allergies**: Any side effects, adverse reactions, or allergies experienced while taking the medications.
10. **Patient Adherence**: Information on whether the patient is taking the medications as prescribed or any deviations from the prescribed regimen.

### Importance of Medication History

1. **Preventing Drug Interactions**: Helps identify potential drug interactions that could lead to adverse effects.
2. **Ensuring Continuity of Care**: Provides a complete picture of a patient's medication regimen, which is essential for ongoing care, especially during transitions between different healthcare settings.
3. **Avoiding Duplications**: Prevents the prescribing of duplicate medications or those with similar therapeutic effects.
4. **Assessing Treatment Effectiveness**: Helps healthcare providers evaluate the effectiveness of current and past treatments.
5. **Identifying Allergies and Adverse Reactions**: Ensures that known allergies and adverse reactions are taken into account to prevent re-exposure to harmful substances.
6. **Patient Safety**: Enhances overall patient safety by ensuring that all medication-related decisions are well-informed.

### Collecting Medication History

Gathering an accurate medication history involves:

- **Patient Interviews**: Direct discussions with the patient or their caregiver to obtain detailed information.
- **Review of Medical Records**: Examination of past medical records, pharmacy records, and prescription databases.
- **Consultation with Other Healthcare Providers**: Communication with other healthcare providers who are or have been involved in the patient’s care.

### Challenges in Collecting Medication History

- **Incomplete Information**: Patients may forget to mention certain medications or supplements.
- **Communication Barriers**: Language differences, cognitive impairments, or literacy issues can hinder accurate information gathering.
- **Multiple Providers**: Patients seeing multiple healthcare providers might have fragmented records.

In summary, a thorough medication history is vital for effective and safe patient care, helping healthcare providers make informed decisions and avoid potential medication-related issues.
 

                                              MEDICATION HISTORY INTERVIEW 

 

 Hello, My name is _____________, I am the pharmacist working on this unit today. I would like to talk to you about your medications.”

                                                         

 Can I have you confirm your full name ?

 

Patient Safety Goal

 As I mentioned, I want to take a few minutes to go over the medications that you take when you’re not in the hospital, so that we can make sure we have an accurate list and the medications that we give you while you’re here will be safe and effective. We will reviewing your drug allergies, immunizations, prescription medications and nonprescription medications. Is now a good time to go through this? (It is important to note that the patient’s safety is one reason we are doing this. Patients are asked about safety on patient satisfaction surveys and this will remind them that this is one of the things that we do for safety)

 

    Medication History

What was the reaction?

 If they First off, what allergies or reactions do you have to medications?

o Did your  say swelling – find out where the swelling was

 

o When did the reaction occur? (i.e. was it recent, was it during childhood, etc)

 

 doctor tell you that you shouldn’t take this medicine again?

 

o Have you taken  to food?  this medicine since the first reaction to it?

 If so, did you experience another reaction?

 

 

, let’s talk about your vaccinations.

 

 Do you remember getting a pneumococcal vaccine? Some people call this a “pneumonia vaccine”.

 

 Do you remember when?

OK

 Now let’s talk about the medicines that you take every day.

o Do you know your medicines well,

 

o Did you bring your medication bottles or a list of your medicines to the hospital with you?

 

 We will use your medication bottles to go make sure we have an accurate list. Then we either need to lock them up outside your room or have one of your family members take them home for you, to make sure we are giving you the safest care possible.

 

Use bottles if available. Verify that the patient is currently taking the medication and the prescribed dose - directions on bottle may have been changed. If patient has med list, read back and verify all items. Ask about items not on the list.

Engage the patient in a conversation about their scheduled medications:

 Drug

 Dose

 Schedule

 Indication

 How long have you been taking?

 Last dose/how many doses taken today if more than once daily

 Now let’s talk about over the counter medicines

 

Ask how often they use and document if clinically significant:

 Vitamins

 Antacids

 Analgesics (esp. ASA, ibuprofen)

 Laxatives, anti-diarrhea agents

 Cold and cough preparations, decongestants

 Topical preparations

 Sleeping agents and sedatives

 Ear and eye products

 Herbal and homeopathic preparations

 

 Are there any medications that you used to take, but have stopped taking in the last 4 weeks? (e.g. antibiotics, changes in chronic therapies, changes in OTCs)

 

 

 What other medicines do you take that we have not talked about yet? Any inhalers, nasal sprays, eyedrops, eardrops, patches, creams, or injections?

 

 

 Thank the patient for their time and information.

 Ask them if they have any other questions.

 Remind patient that we will be in to discuss any changes to medications and provided updated list prior to discharge.

 

 

 Patient is on warfarin PTA

o Ask patient for the following information:

 Indication

 INR goal

 Recent INR/date of ACC visit

 Current regimen, and how long they have been on this dose (stable?)

 Who doses warfarin/follows INR

 Last dose/any missed doses recently

 Patient is on antibiotics/recently finished antibiotics

o Ask patient for

 Indication

 Intended length of treatment

 When antibiotics were started (what day of treatment)

 Last dose

 Patient reports a penicillin-allergy

o Ask patient what reaction and when

o Has patient ever had other antibiotics? (throw out a few names, like cephalexin or cefazolin)

 Patient may be non-compliant with medications

o Ask patient for pharmacies where medications are filled

o Ask for other pharmacies where patient may fill (some patients may forget about mail order)

o Obtain recent fill dates

 Ask pharmacy for meds filled in past 3-4 months

 Patient may fill 90day supply, so the most recent month may not be sufficient

 Patient refuses to participate in medication history

o Ask patient for pharmacy where fills and permission to call

 Ask pharmacy for medicines, filled in past 3-4 months