Obtaining a Best Possible Medication History in Hospitals

Completing a best possible medication history (BPMH) is a crucial first step in the medication reconciliation process.

According to the Institute for Healthcare Improvement, medication reconciliation is the “process of creating and maintaining the most accurate list possible of all medications the patient is taking, including drug name, dosage, frequency, and route.” It’s not a one-time event, but a continuous process to be repeated upon transitions of care, including hospital admission, relocation, and discharge.

The BPMH obtained in the emergency room (ER) upon admission sets the stage for reducing medication errors, ensuring patient safety, and improving patient care. Although the procedure is standardized, I’ve spent the summer training and practicing taking patient’s medication histories, and I haven’t met a single “standardized patient” outside of a clinical simulation at school. This is where the qualifier “best possible” comes in.

As any pharmacist would expect, some patients are able to provide more information than others. The aptitude of a patient as a historian of medications can vary depending on a multitude of factors, including but not limited to physical condition upon ER admission. Some patients have their medications managed by a facility or family member, while others come in with bottles of their medications. Even when these puzzle pieces are presented, however, they must be reviewed with a discerning eye given to dates, dosage regimens, and details.

If patients don’t know their medication regimen, they may be able to tell you what pharmacy (or pharmacies) they go to, who their primary care provider is, and whether they’ve stopped taking a medication they may have recently filled. Although a complete history requires the drug name, dosage, frequency, and route, additional questions may be required to determine whether the patient is taking the medication as prescribed, and whether it’s a PRN or scheduled medication.

This interview needs to be completed sometime between the patient’s visits from registration, the attending physician, or certain procedures, but before they head up to the floor. In the short time I’ve been in this department, I’ve practiced the art of being thorough without becoming overwhelming.

Good communication among hospital and community pharmacies, assisted-living facilities, and physician’s offices is essential. A phone call often becomes necessary if all you got from the patient interview is a “blood pressure medication” or “lisinopril”, especially when patients are unsure about how they’re currently taking a medication like warfarin. The best practice for making home medication list requests to outside facilities merits its own discussion, but it definitely involves a combination of patience, persistence, and thorough understanding of HIPAA.

Software connecting the history of recently filled medications with patient profiles at the hospital could greatly enhance pharmacists’ ability to obtain a more accurate history. However, it would require cooperation from insurance companies, as well as the hospitals and community pharmacies involved.

From the hospital’s end, medication fill history can show whether the medications are filled regularly, whether there have been recent dosage changes, and much more. This software would also decrease the number of inquiries made to outside pharmacies about patients’ medication profiles. From all aspects of health care, it’s a win-win.

It’s my hope that hospitals, pharmacies, and other key players on the same team will continue to work together to enhance patient care and reduce medication errors by always asking, “How can we make this better?”