Title 6. MEDICATION HISTORY.pdf ✅

PHARMD GURU Page 1 MEDICATION HISTORY INTRODUCTION TO MEDICATION HISTORY: • An accurate medication history provides a foundation for assessing the appropriateness of a patient’s current therapy and directing future treatment choices. • It can prevent medication errors and during the process of obtaining a history other pharmaceutical issues such as poor or non-adherence can be identified. • It is important as part of your clinical role as pharmacists, that the medication histories you undertake are accurate to ensure patients’ current and future therapy is safe and effective. DEFINITION OF MEDICATION HISTORY INTERVIEW: A structured critical examination of a patient’s medicines by a healthcare professional: • Reaching an agreement with the patient about treatment. • Optimizing the use of medicines. • Minimizing the number of medication-related problems. • Avoiding wastage Regular medication review maximizes the therapeutic benefit and minimizes the potential harm of drugs. It ensures the safe and effective use of medicines by patients. Medication review provides an opportunity for patients to discuss their medicines with a healthcare professional. Medication review is the cornerstone of medicines management. GOALS 1. To optimize the patients drug therapy. 2. To prevent (or) minimize drug related problems/medication errors. DEFINITIONS, DEVELOPMENT AND SCOPE OF CLINICAL PHARMACY
PHARMD GURU Page 2 What does medication review involve? • A structured critical examination of a patient’s medicines (prescription and other medicines, including alternatives) by a healthcare professional. • Identification, management, and prevention of ADRs or drug interactions. • Minimizing the number of medication-related problems. • Optimizing the use of medicines. • Simplification of regimen. • Ensuring all drugs is appropriate and needed. • Avoiding wastage. • Medication counseling. • Adherence counseling — to encourage patients to adhere to their drug regimens. • Assessment of ability to self-medicate. • Education of patient or care taker — to help them understand their drugs better. • Education of the patient on safe and effective medication use. • Forum for suggesting effective treatment alternatives. • Recommendation of compliance aids. Principles of medication review: • Patients must be informed that their medication is being reviewed. • Patients should have the opportunity to ask questions and highlight and problems with their medicines • Medication review should improve the impact of treatment for an individual patient. • A competent person (e.g. pharmacist) should undertake the review in a systematic way. • Any changes resulting from the review are agreed with the patient. • The review is documented according to local policy (e.g. in the patient’s notes). • The impact of any change is monitored.
PHARMD GURU Page 3 LEVELS OF MEDICINE REVIEW Level 3 (clinical medication review) • Face-to-face review of medication with the patient and their notes, specifically undertaken by a doctor, nurse, or pharmacist. • Provides an opportunity to discuss what medication the patient is actually taking and how medicine-taking fits in with the patient’s daily life. Level 2 (treatment review) • Review of medicines, with reference to the patient’s full notes, in the absence of the patient and under the direction of a doctor, nurse, or pharmacist. Level 1 (prescription review) • Technical review of a list of the patient’s medicines in the absence of the patient and under the direction of a doctor, nurse, or pharmacist. Level 0 (ad hoc review) • Unstructured, opportunistic review of medication. WHO TO TARGET: • Patients on multiple medications or complicated drug regimens • Patients experiencing ADRs. • Patients with chronic conditions. • Elderly patients. • Non-adherent patients. POTENTIAL BENEFITS OF MEDICATION REVIEW: • Identification, management, and prevention of ADRs. • Ensuring patients have maximum benefit from their medicines. • Decreases the risk of drug-related problems. • Increases the appropriate use of medicines. • Improved clinical outcomes.
PHARMD GURU Page 4 • Cost-effectiveness. • Increases the quality of life. • Optimizing therapy. • Decreases the waste of medicines. • Enables patients to maintain their independence. • Decreases the admissions to hospital. • Decreased in drug-related deaths. PROBLEMS IDENTIFIED DURING A MEDICATION REVIEW: • Potential ADRs. • Potential interactions (drug–drug or drug–food). • Suboptimal monitoring. • Adherence/lack of concordance issues. • Misunderstanding of dose directions. • Impractical directions. • Incorrect/inappropriate dosages. • Drugs no longer needed (e.g. one medication used to treat the side effects of another). • Difficulties with using certain dose forms (e.g. inhaler or eye drops).