The clinical pharmacist plays a number of roles in patient care the highlights of, which have been mentioned in the previous blog. Medication history interview is the first of the various roles played by him. It is an important information resource tool in the hands of a clinical pharmacist with the aid of, which they try to obtain accurate medication histories from the patients or other sources or by verifying medication histories obtained by other healthcare professionals. Medication history interview is conducted for inpatients as well as outpatients. Practically speaking it is not possible to conduct interviews for all the patients hence, it is important to select those patients where maximum benefit is likely to be obtained. This special patient group includes:-
1. Patients with serious and /or unstable disease states
2. Patient receiving specific medications, ex- drugs with narrow therapeutic index
3. Patient treated with complex drug regimens
4. Patient whose established medications have been altered
5. Elderly or paediatric patients
6. Patients identified as non-intentional non-compliers
7. Patient with language and reading difficulty
In some cases with cognition, lack of alertness, agitation or delirium conducting medication history interview is not appropriate. Information in such cases is obtained from the family members of the patients.
However before conducting an actual interview it is necessary to determine the goals of the interview. The goal of the medication history interview is oriented towards to obtaining information on aspects of drug use that may assist in the overall care of the patient. The information gathered can be utilized to
• compare medication profiles with the medication administration record and investigate discrepancies
• verify medication histories taken by other staff and provide additional information where appropriate
• document allergies and adverse reactions
• screen for drug interaction
• assess patient medication compliance
• appraise drug administration techniques
• examine the need for medication aids
• document patient- initiated medication administration
During the interview the patients are asked to produce documents such as current medication administration record, previous prescriptions, which includes discharge prescription and outpatient prescriptions, current admission details which includes medical and nursing notes, referral letter from local doctor or other sources and the patient’s medication list.
Besides analyzing and evaluating the previous document the clinical pharmacist seeks detailed information regarding prescription medication use, non-prescription medication use, allergies, previous adverse drug reactions and their manifestation, use of alternative therapies, social drug use or illicit drug use, immunization status and community pharmacies and general practice surgeries visited.
On the basis of the medication history interview the clinical pharmacist identifies and resolves any drug –related problem. He develops strategies to overcome problems such as side effects and drug interactions if these are identified. He compares the medication profile with the medication administration record at the time of admission, and investigate any discrepancies if found. He may contact the prescribing doctor if necessary.
Furthermore medication history interview provide opportunity for pharmacists to establish rapport with the patient and explain their role in the patient’s care, commence preliminary counseling and reinforce the principles of quality use of medications and use the information obtained to form the basis of an ongoing pharmaceutical care and plan.
Thus to conclude with the help of medication history interview the clinical pharmacist contribute significantly to the patient care.