2. Introduce yourself (use full name and title) and tell them what you are going to do (obtain a medication history).
3. Build rapport (make good eye contact, smile, greet them, etc)
4. Identify the patient (at least two identifiers). If step one not applicable, let the patient introduce themselves. Ideally you want to obtain information directly from the patient. If the patient cannot give information directly because of a language barrier use a translation service. Generally family members should be avoided because of confidentiality issues eg the patient may not want to admit how much they smoke or drink.
5. Consider how reliable the source of information is. Is the patient a child, demented, too sick to fully concentrate. If possible, have the patient bring in all of their medications in a "brown bag".
6. What to ask about prescriptions/OTCs/supplements? Name, strength, directions, indications and adherence. Also ask if the drug is working for them and assess for interactions, adverse effects, environmental exposures (pesticides and other chemicals in the work place) and allergies. 7. Don't forget to get an immunization history: Influenza, pneumonia, tetnus, shingle, hepatitis etc.
8. Habits? (ie alcohol, tobacco, caffeine, recreational drugs) Possible withdrawal concerns, especially in hospital settings.
9. Inquire about past medications. Ask about past changes, if any. (e.g. why was the strength increased? Was it too expensive?)
10. Document a patient’s compliance when possible. Look for signs of patient's compliance (ie via pill counts,blood levels, surrogate markers, etc)
11. Ask what other pharmacies the patient goes to (do they go to one or multiple pharmacies to get their drugs?)
12. At the end, make appropriate recommendations such as increasing or decreasing doses, adding or deleting medications etc.
Posted by: Stephanie Shieh; PharmD Candidate 2014
Edited by: Adrian Lee; PharmD candidate 2014