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Medication Management / Pharmacist

Best Possible Medication History (BPMH) Guide

Wenya Miao (BScPhm, PharmD, ACPR) and Chris Fan-Lun (BScPhm, ACPR, BCGP), pharmacists at Mount Sinai Hospital in Toronto share a script that any health care provider can use in the ED to ensure an accurate medication history — before discharge or before admission.

Best Possible Medication History (BPMH) Guide

Here is an outline for a script that any health care provider can use in the ED to ensure an accurate medication history — before discharge or before admission:

Introduction – Introduce self and profession

  • I would like to take some time to review the medications you take at home.
  • I have a list of medications from your chart/file, and want to make sure it is accurate and up to date.
  • Would it be possible to discuss your medications with you (or a family member) at this time?

Medication Allergies

  • Do you have any medication allergies? If yes, what happens when you take__ _?

Information Gathering

  • Do you have your medication list or pill bottles (vials) with you?
    • Show and tell technique when they have brought the medication vials with them.
  • How do you take (medication name)?
  • How often or when do you take (medication name)?
    • Collect information about dose, route and frequency for each drug. If the patient is taking a medication differently than prescribed, record what the patient is actually taking and note the discrepancy.
  • Are there any prescription medications you (or your physician) have recently stopped or changed?
  • What was the reason for this change?

Community Pharmacy

  • What is the name of the pharmacy that you normally go to? (Name/Location: anticipate more than one)
  • May we call your pharmacy to clarify your medications if needed?

Over the Counter (OTCs) Medications

  • Are there any medications that you are taking that you do not need a prescription for? (Do you take anything that you would buy without a doctorʼs prescription?) Give example, e.g. Aspirin. If yes, how do you take ________?

Vitamins/Minerals/Supplements

  • Do you take any vitamins (e.g. multivitamin)? If yes, how do you take __?
  • Do you take any minerals (e.g. calcium, iron)? If yes, how do you take __?
  • Do you use any supplements (e.g. glucosamine, St. Johnʼs Wort)? If yes, how do you take them __ ?

Eye/Ear/Nose Drops

  • Do you use any eye drops? If yes, what are the names and how many drops do you use and how often? In which eye?
  • Do you use any ear or nose drops/nose sprays? If yes, how do you use them?

Inhalers /Patches/Creams/Ointments/Injectables/Samples

  • Do you use any inhalers? any medicated patches? medicated creams or ointments? any injectable medications (e.g. insulin)? For each, if yes, how do you take ___? (name, strength, how often)
  • Did your doctor give you any medication samples to try in the last few months?

Antibiotics

  • Have you used any antibiotics in the past 3 months?

Closing

  • This concludes our interview. Thank you for your time. Do you have any questions?
  • If you remember anything after our discussion please contact me to update the information?

Exit room and wash hands. Proceed to document interaction in chart/file.

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Wenya Miao - BScPhm, PharmD, ACPR

Wenya Miao is a pharmacist at Mount Sinai Hospital, Toronto, and is a member of the Geriatric Emergency Department Interdisciplinary team.

No photo available
Chris Fan-Lun - BScPhm, ACPR, BCGP

Chris Fan-Lun is a pharmacist at Mount Sinai Hospital, Toronto, and is a member of the Geriatric Emergency Department Interdisciplinary team.

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