Transcript 313 PHCL med Hx lect..
TAKING MEDICATION HISTORIES
EMTENAN ALHARBI ,Msc Clinical Pharmacy Department
2 Learning Objectives
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Importance of medication history by pharmacist State the advantages & disadvantages of interviewing patients before and after review of patient information Identify the most relevant information from observing patient surroundings List the categories of data to be collected during the interview 5.
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Describe the type of information under each category Differentiate between allergy and ADR.
State how to assess patient compliance. Identify types of questions to use and to avoid.
Discuss the different type of documentation styles
Medication history.. Importance
Side effects, allergy The role of medications in the treatment of disease
Med Hx starting point for clinician to identify the patient’s understanding of
Patient’s compliance Medication’s effectiveness
Why pharmacists?
Unique combination of drug related expertise and experience; Patient trust and respect pharmacists
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Errors attributed to incomplete Medication History
Errors of omission Errors of commission Incorrect dose Incorrect frequency Incorrect strength Incorrect name Incorrect dosage form
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
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What are the sources for patient information?
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Sources of Information for patient database 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
Before the Interview • Preparation • Observation of patient and his environment During the Interview • Data to be collected • Communication skills After the Interview • Documentation of the Med Hx
Preparation
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Review the patient‘s information
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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
11 Preparation.. Observe Patient and his Surrounding
Patient state of health Socioeconomic status e.g. Cost of med.
Compliance with dietary recommendations e.g
. Antihypertensive agent & salt restriction Social support system
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Data Collection What type of information is included during a medication history session?
PHCL 326: communication skills for Pharmacists 4/24/2020
Data to be Collected
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Demographic Information Dietary Information Social Habits Current & Pat Rx medications Current & Past OTC medication Current & Past alternative remedies Allergies Adverse drug reactions Compliance assessment
Demographic Information
Age/date of birth Gender Height and weight Race and ethnic origin Residence Education Occupation Life style
Dietary Information
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Restrictions Supplements Stimulants suppressants
Social Habits
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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
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Social Habits..Packs-Year
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)
Social Habits..Example
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a patient who has smoked 15 cigarettes a day for 40 years has a: (15x40)/20 = 30 pk-yr smoking history. A patient who smoked 2 packs per day for 5 years 2x5= 10 pk-yr smoking history.
Current Rx medications
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Name/description Dosage Dosing schedule (prescribed, actual, PRN) Indications Date med started Outcome of therapy
Past Rx medications
Name/description Dosage Dosing schedule (prescribed, actual, PRN) Indications Date med started Date med stopped Reason for stopping Outcome of therapy
Current & Past OTC medication
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Name/description Dosage Dosing schedule (recommended and actual) Indications Date med started Date med stopped Outcome of therapy Reasons for stopping the med
Current & Past Alternative Remedies
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Name/description Dosage Dosing schedule (prescribed and actual) Indications Date remedy started or stopped Outcome of therapy Reasons for stopping the med
Allergies
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Name & description of causative agent Dosage Date of reaction Description of reaction How the reaction was treated
Adverse Drug Reactions
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Name & description of causative agent Dosage Date of reaction Description of reaction How the reaction was treated
Immunization
Vaccines Date of administration
Compliance Assessment
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Causes of non-compliance ADR Cost Unavailability Inappropriate dosage form Not understanding the reason for taking the medication Deliberate
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Questioning Techniques
Open-ended questions
Close-ended questions
Targeted questions
Leading questions
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Setting the stage for the interview
29 Pay attention to communication skills
30 Avoid Hindering Behaviors
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
Documentation
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Standardized Freestyle SOAP
Individual Assignment
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Find a relative, neighbor or a friend and obtain a medication history from Use the standardized data collection sheet