Medication history Interview and sensitivities, prescription and

nonprescription medication use,

• The medication history is the foundation use of alternative remedies,
for planning optimal patient-specific immunizations, and reliability in
medication regimens. taking scheduled doses.
• The medication history is the starting point
for generating hypotheses regarding
1. The patient’s understanding of the Consequence of incomplete or incorrect
role of medications in the treatment medication histories
of disease; • It may put the patient at risk due
2. The patient’s ability to comply with to
the medication regimen; o Interrupted therapy
3. The medication’s effectiveness; o Unnecessary therapy
4. The patient’s experiences with side o Duplicative therapy
effects, allergies, and adverse drug o Incorrect therapy
reactions. (inappropriately low or
high dosages).
Before... For hospitalized patients, the medication
• Pharmacists relied on other health care history is the first step in the medication
professionals to obtain and document reconciliation process.
information regarding medications taken
by patients. Medication Reconciliation
• Many medications in the early twentieth
century were relatively ineffective and • A process of comparing the
had few known risks, so most health care patient’s preadmission
professionals had little interest in or need medications with the medications
for detailed medication histories. prescribed during the
• Pharmacists had limited direct patient hospitalization,
care responsibility and did not need • It is intended to prevent
firsthand knowledge of patient medication-related patient
medication use. safety problems such as errors of
omission and duplication as well
Now… as drug-drug and drug-disease
1. The role of pharmacists in obtaining, interaction errors.
documenting patient medication
histories and communicating this 2 approaches to preparing for a patient
information to the rest of the health care interview
team is being recognized for the 1. To review all that is known about the
following reasons patient’s medical condition and
• Pharmacists have a unique medications and then target the
combination of drug-related interview to specific issues identified
expertise and experience during the review.
• Increasing availability of potent • Commonly used when patients
prescription and nonprescription are admitted to acute care or
medications long term care institutions where
• Increasing fragmentation of the physicians and nurses have
health care system. already documented at least
some patient information.

Characteristic of medication histories

obtained by health care professionals other Advantage
than pharmacist a. The pharmacist has some knowledge of
• Lack important information the patient before the interview.
regarding medication allergies

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b. The Pharmacist can prepare to explore 2. To interview the patient before reviewing
and address specific issues; any previously documented patient
c. The pharmacist may feel more information.
comfortable having this knowledge • Commonly used in community
before interacting with the patient. based setting.
d. The interview may be more fluid with
fewer gaps to fill in, Advantage
e. The pharmacist may be better prepared a. The pharmacist is completely unbiased
to deal with provider safety issues (e.g., about each patient and the patient’s
ways to cope with a potentially violent history, which allows the exploration of
patient, the need for contact all aspects of the medication history with
precautions, etc.). equal intensity.

Disadvantage Disadvantage
a. Important information may be a. It can be an intimidating and time-
overlooked if the pharmacist becomes consuming process for the inexperienced
too focused or unduly influenced by interviewer.
previously obtained information.

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Read pages 33-38 of the reference book Clinical Skills for Pharmacists: A Patient Focused
Approach for the detailed discussion about the content of a medication history interview.

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DOCUMENTATION OF THE MEDICATION Disadvantage
HISTORY INTERVIEW • The information is well organized,
but it is hard for readers to scan
a. Standardized medication history forms the document for specific
Advantage information.
• Relatively easy to complete and c. Free style format
are easy to scan for specific Advantage
information. • organizes the information into
Disadvantage whatever structure the
• Standardized forms are inflexible pharmacist thinks best for the
and may not contain adequate information It is easy to write a
space for documentation of medication history in a freestyle
patient-specific information. format
b. SOAP format Disadvantage
Advantage • Finding specific details may be
• The SOAP format organizes the difficult. Important information is
medication history information more likely to be left out in this
into four sections: subjective format than with other formats.
data, objective data,
assessment, and plan.

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