Module 1-medication, History -Taking Flashcards
BID
Twice a day
BPMH
“ best possible” medication history
CI
Confidence interval
ED
Emergency department
EHR
Electronic health record
HD
Hospital day
MRA
Medication, reconciliation assistance
med rec
Medication reconciliation
PAML
Pre-admission medication list
PO
My mouth
RCT
Randomized controlled trial
RN
Registered nurse
The majority of potential harmful medication discrepancies in hospital order are due to errors
In :
Medication history-taking
In recent studies, such as a book key, MARQURIS2, the receipt of patient level interventions, such as a “BPMH,” can result in how large of a reduction in medication discrepancy in admission and discharge orders? 

60%
Medication reconciliation errors in control group of partner RCT
Potential for harm 27%
History error 72%
Reconciliation error 30%
1- BPMH
2-reconciliation at discharge
3-patient counseling.
4-forward information to next provider.
Medication reconciliation bundle:
Risk assessment :
-intense vs. Standard bundle depending on patient risk.
Intervention components :
1-medication reconciliation bundle.
2-risk assessment.
3-train providers in taking a BPMH and in performance discharge counseling
4-improving access to pre-admission medication sources.
5- other the risk, high reward interventions
Improving access to pre-admission medication sources:
-Encouraging patient all medication list.
-Facilitating assess to other medication sources example pharmacy
Other high risk, high reward interventions
-Implementing and improving health information technology
-utilizing social marketing.
-Engaging community resources
Why is this hard?
-Information system that don’t talk to each other.
-Lack of single “ source of truth”
-Fragmented healthcare system
-many transition care
-Lack of communication between patient and providers( and
among providers)
-Patient who may not be engaged in their own healthcare, have low health literacy,
-few social support.
-
Why is this hard?
-poly pharmacy,
-frequent changes in regiment,
-lack of value place on medication reconciliation.
Best possible medication history barriers:
-We need an army of trained, competent, upper BPMH -takers
-That’s why you are here
Conclusions:
error in medication history taking are the most common cause:
-error in medication history taking are the most common cause:
1-of unintentional medication
2-, discrepancy in admission and
3- order in hospital
Conclusion
-Recent study have shown accurate history taking can be performed by pharmacy technician, and that this action can lead to a substantial reduction in medication discrepancy
Conclusion : Barrier to accurate medication history includes:
- the complex and fragmented US ‘,’
- system lack of interoperability of medication history sources,
- lack of patient understanding on their medication,
- and poly pharmacy
Why the medication history is important ?
1-A good medication history is a critical for patient safety.
2-error in medication history:
— account for up to 75% of all potentially harmful medication, discrepancy in admission and discharge order
A process of identifying the most accurate list of all medication a patient is taking and should be taking, including them, dosage, frequency, route, purpose, and duration.
And use this list to provide correction medication for patient anywhere within healthcare system. This definition is compatible with that of the joy commission and also include ordering medication accuracy, which is ultimately the purpose of medication reconciliation.
Definition
Medication reconciliation
