Patient Medication History Interview.pptx

Patient medication history interview
Need for the patient medication history interview, medication interview forms.

1. Patient Medication History Interview Mr. Mangesh Bansod

2. Introduction A medication history comes under pharmaceutical consultation that identifies and documents allergies or other serious adverse events caused by a drug. It also includes information on the current and past considerations about medicines. It is a beginning for medicines reconciliation and review. A positive effect on patient care is observed when accurate and complete medication histories are taken.   Medication history interview involves interviewing a patient for collecting the data medical history. The history attained by the medical team and the pharmacist may differ and fall into two categories, i.e., intentional (when medical team makes a decision of changing the regimen) or unintentional (when complete record was not available). Differences should be clarified with the prescriber or the senior pharmacist. Firstly the pharmacist should get familiarise with the patient charts to know the present medical status and background particulars of the patient. The interview should be started with introduction and the reason for interview. The patient’s name, address, age, and past medication history should be jotted down .

3. Introduction Direct or indirect questions can be put forward on primary issues , like prescribed medication, self-medication, allergies, undesirable effect of any drug, compliance to prescribed medication, and smoking, drinking and eating habits. The language or terminologies should be simple and easy to understand by the patient. If the patient has difficulty in understanding specific terms, the pharmacist should explain it properly. Secondary relevant areas for questioning are constipation, diarrhoea , cough and cold, lay fever, allergies, vitamins, tonics and skin preparations. At last , when patient’s confidence is achieved by the pharmacist through the interview, questions on patient’s medication compliance could be asked. It is supportive information for the drug therapy. All the details gained during the interview are noted down in a sheet, one copy of which is sent to the physician.

4. Need for the Patient Medication History Interview It gives information about the drugs taken by the patient in the past or being taken at the present time. Information on the responses of drugs administered in the past help in planning the future treatment. It informs about the drug effects, as drugs may give rise to a disease either directly or due to an interaction. The drugs the patient is currently taking can mask clinical signs; for example , β- adrenoceptor antagonists prevent tachycardia in a patient with haemorrhage ; corticosteroids prevent abdominal pain and rigidity in a patient with perforated duodenal ulcer. Drugs the patient is currently taking can also affect the results of diagnosis; for example , amiodarone alters the results of thyroid tests. An inaccurate history on admission to hospital results in unwanted duplication of drugs, drug interactions, discontinuation of long-term medications, and failure to detect drug -related problems. Such prescription errors can be prevented by medication history.  

5. Need for the Patient Medication History Interview   Interview on medication history gives information on drug use which may assist in patient care. The information obtained can be utilised for: Comparing medication profiles with the record of medication administration, Investigating the discrepancies, Verifying medication history taken by other staffs and providing additional information where needed, Documenting allergies and adverse reactions, Investigating drug interactions, Evaluating patient medication compliance, Investigating the rationale for drug prescribed, Screening the evidence of drug abuse, Evaluating the drug administration techniques, Investigating the needs for medication aids, and Documenting patient initiated medication administration.

6. Components The pharmacist should introduce himself/herself to the patient and explain the intention of consultation. The pharmacist should identify any allergies or serious adverse reactions and mention them on prescription chart, care notes, or patient medication record. The pharmacist should get details on prescribed and non -prescribed treatments from the patient’s recall, medicines possessed by the patient, referral letter (from the patient’s primary care doctor), copy of prescriptions issued or a repeat prescription list, medical notes, and by contacting the appropriate community pharmacist or primary care doctor. The pharmacist should make sure to document the generic name of medicine , dose, frequency, and duration of therapy. The pharmacist should also document inhalers, eye drops, topical medicines, and herbal and homoeopathic remedies possessed by the patients. The pharmacist should understand the patient’s medication-taking behaviour . The pharmacist should consider problems like swallowing difficulties, understanding labels and written information, container preferences, and ordering or supply issues .

7. Components The pharmacist should record the history in detailed format. The pharmacist should jot down any variation in the history recorded by other healthcare professionals. The pharmacist should know if these variations are intentional (from patient, nursing staff, medical staff, or medical notes) or unintentional. The pharmacist should inform about the unintentional variations to the prescriber. The pharmacist should document all the medication -related information properly, e.g., implications of chronic renal failure, dialysis, and long-term steroid treatment.

8. The vital communication skills a pharmacist need to possess while taking a medication history interview Skills Details Examples Formal form of address The pharmacist should use the patient’s title and last name. “Good Morning Mr. Kapoor .” Rapport The pharmacist should actively listen to confirm interest in a patient and gain respect. “It is not easy being in the hospital away from friends and family.” Active listening or empathic responding The pharmacist should understand the patient’s feelings. “ You sound unsure.” Or “Are you saying.” Open-ended questioning The pharmacist should make the patient feel free to answer in any manner. This is useful when a new subject is introduced. “How are you taking your blood pressure medicine?” Close-ended questioning The pharmacist should allow the patient to answer in either yes or no. “ Do you take your blood pressure medicine in the morning?” Transition The pharmacist should verbally end one subject and introduce a new one to allow the patient to make a mental transition. “We have just talked about the prescription medications you take. Now let us talk about any non -prescription medications you may take.” Verbal following The pharmacist should elaborate a subject to the patient without asking new questions, but only repeating the patient’s last few words. “… dizzy spells?” Avoidance of leading questions The pharmacist should ask leading questions so that the patient gives particular answer. “ You do not smoke, do you?” or “Do you use any tobacco products?” Avoidance of “Why” questions “ Why” questions can make the patients defensive, so the pharmacist should r e-phrase the questions and begin with “for what reason”. “Why were you takin g the medicine in the morning?” should not be asked and instead “For what reason…..”. Timing The pharmacist should w arn a patient before asking a series of questions. “I am going to ask you a series of questions now.” Clarify conflicting information The pharmacis t should a lways accept the blame for inconsistent information that the patient may tell or write. “I must have written it incorrectly, I thought you had said…”

9. the vital communication skills a pharmacist need to possess while taking a medication history interview Silence The pharmacist should allow the patient to show emotion, digest information, or gather thoughts. The pharmacist should also maintain non -verbal assistance and stop speaking. Answering patient questions The pharmacist should a void definitive answers until a final drug therapy is planned. If patients ask, “Do you think I should stop taking …. ?”, the pharmacist should answer “ Well, I will make a note and evaluate it with Dr. Smith”. Mentioning previously answered questions The pharmacist should note down the answers given by the patients to a question he/she was going to ask later in the interview. “You mentioned earlier that you occasionally take ibuprofen for headaches. Do you ever take anything else for aches or pain?”

10. Steps Involved and Data to be Obtained While interviewing the patients about their medication history, the pharmacists should follow the given procedure: Patient Selection: The pharmacist should identify the patients who are likely to be benefitted from the interview. Self-Preparation: The pharmacist should understand the medical condition of patients and also their therapy before beginning the interview. Introduction: The pharmacist should introduce himself/herself and explain the purpose of interview to the patients. Conduct Interview: The pharmacist should collect all significant information using various open-and close-ended questions. Conclusion: The pharmacist should prepare a summary of all the important is sues and give clarification for the same. Documentation: The pharmacist should document the information gathered during the medication history interview for future reference.

11. Demographic Information Age/date of birth Height and weight Race and/or ethnic origin Type of residence Education Occupation Dietary Information Dietary restrictions Dietary supplements Dietary stimulants Dietary suppressants Social Habits Tobacco use Alcohol use Illicit drug use Current Prescription Medications Name (proprietary and non-proprietary) and/or description Dose Dose schedule (prescribed and actual) Reason for taking the medication Start date Outcome of therapy

12. Past Prescription Medications Name (proprietary and non-proprietary) and/or description Dose Dose schedule (prescribed and actual) Reason for taking the medication Start and stop date Reason for stopping Outcome of therapy Current Non-Prescription Medications Name (proprietary and non-proprietary) and/or description Dose Dose schedule (recommended and actual) Reason for taking Start date Outcome of therapy Past Non-Prescription Medications Name (proprietary and non-proprietary) and/or description Dose Dose schedule (recommended and actual) Reason for taking Start and stop date Reason for stopping Outcome of therapy

13. Past Complementary and Alternative Me dicines Name (proprietary and non-proprietary) and/or description Dose Dose schedule Reason for taking Start and stop date Reason for stopping Outcome of therapy Allergies Drug name and description Dose Date of reaction Description of reaction Treatment for the reaction Adverse Drug Reactions Drug name and description Dose Date of reaction Description of reaction Treatment of the reaction Immunisations Vaccines Date each vaccine was administered Overall Patient Adherence

14. Medication Interview Forms