PMM Medication History/Review

Question 1

What should you always specify about a patient’s dose of benzodiazepines in a medication history?

Answer 1

We need to confirm whether a patient’s use of benzodiazepines is regular or PRN.

Question 2

In what instance(s) should you ask a patient when they last had their medication(s) as part of a medication history?

Answer 2

You should always ask patients when they last had their medications as part of a medication history, especially in the surgical setting.

Question 3

If you see a patient is on gentamicin before a medication history, what should this serve as a prompt to do?

Answer 3

Check their height and weight

Question 4

What are three limitations to My Health Record?

Answer 4

1. Not all pharmacies upload to My Health Record
2. Directions may be omitted
3. May not reflect what the patient is actually doing (i.e. change of dose since last prescription)

Question 5

What is a good resource to use for dosing of DDAs for a best-possible medication history?

Answer 5

ScriptCheckSA

Question 6

What is often a simple yet effective way to assess a patient’s compliance?

Answer 6

Ask their family members.

Question 7

What is a good sign you should use another source in a best-possible medication history?

Answer 7

If you are not sure about any of the details, you should seek another source to confirm.

Question 8

If you’re doing a best-possible medication history with a patient over the phone, what should you always ask?

Answer 8

Confirm if they have their medications in front of them.

Question 9

Why can you never completely trust My Health Record even if a patient only goes to one pharmacy and all details are provided?

Answer 9

The My Health Record server goes down from time to time so records can be omitted.

Question 10

What should you always do immediately before submitting a document on Sunrise?

Answer 10

Check the document preview.

Question 11

If a patient has a low GFR, what should this serve as a prompt to do?

Answer 11

Check their height and weight to get a creatinine clearance

Question 12

What should you always check on MyHealthRecord besides medications?

Answer 12

Patient allergies

Question 13

What should you always do if you notice VTE prophylaxis has not been charted?

Answer 13

Query if this was intentional and if not chase with the team.

Question 14

If a medication is not charted, what should you always check?

Answer 14

You should check the admission note to see if it was missed by the team.

Question 15

What is the first thing you should always check in a medication review for a pregnant patient?

Answer 15

If the medications the patient is taking are safe to use in pregnancy.

Question 16

What document should you check for every patient every day?

Answer 16

MEDical progress note

Question 17

What are 12 formulations you should always ask patients about while taking a medication history?

Answer 17

1. Eye Drops?
2. Ear Drops?
3. Nasal Sprays?
4. Puffers/Inhalers/Sprays?
5. Wafers/Pain Medications?
6. Sleep Medications?
7. Stomach Medications?
8. Vitamins/OTC?
9. Cream/Ointment?
10. Patches?
11. Injections?
12. Contraception/HRT?

Question 18

What are 13 sources of information you can use in a medication history?

Answer 18

1. My Health Record
2. ScriptCheckSA
3. Patient
4. Carer
5. Patient’s Own Medicines/Webster Pak
6. Patient Medication List
7. iPharmacy
8. Oacis/Oacis View
9. Previous Admission
10. Community Pharmacy
11. General Practitioner
12. Aged Care Home
13. Other Hospital

Question 19

What should you always check when you call a pharmacy regarding a nursing home patient?

Answer 19

Confirm which medications are packed and which aren’t packed.

Question 20

What should you always do in a medication history document for a medication dose that requires more than one tablet/capsule?

Answer 20

Specify how the patient makes up the dose

Question 21

What should you always consider adding in the “Reason for Admission” section of a PMM Medication History note?

Answer 21

You should consider adding the most recent problem list, especially if they have been in for a few days before you get to see them.

Question 22

If a patient denies allergies documented on their record, what should you do?

Answer 22

You should always document them. You may wish to note that the patient denied them, but if you don’t document them, you’re not covered.

Question 23

What should you always consider when undertaking a medication reconciliation for a patient who has transferred from another hospital?

Answer 23

You should reconcile against both their medicines from home, and the medicines started at the previous hospital, to ensure nothing has been overlooked.

Question 24

What should you always check when you see a medication history from another pharmacist?

Answer 24

Check the pharmacist has actually seen the patient.

Question 25

What should you always aim to document for each drug in a medication review?

Answer 25

The indication and/or rationale behind any changes.

Question 26

If you can’t find an echocardiogram report in Sunrise, what is a good place to look?

Answer 26

In the patient’s black folder.

Question 27

What must you do if you document something unusual?

Answer 27

You must always acknowledge it is unusual, otherwise people may assume it is a mistake.

Question 28

What should you always do when a patient has a new current issue?

Answer 28

You should always check their recent medication changes to see if they are implicated in causing the issue, or if something which will treat the issue is on hold, rather than piling on new medications.