© Institute for Safe Medication Practices Canada 2008® The 30 Minute BPMH Work Out: Tips, Tools and Strategies for Getting an Efficient and Complete Best

© Institute for Safe Medication Practices Canada 2008®

The 30 Minute BPMH Work Out:Tips, Tools and Strategies for Getting an Efficient and Complete Best Possible Medication History

Olavo Fernandes BScPhm, ACPR, PharmD, FCSHPConsultant, ISMP Canada

Assistant Professor and Pharmacy Clinical Site Leader

University Health Network/ Univ. of Toronto

Improving Resident Safety with Medication Reconciliation Conference

Moncton, September 2008

Handout VersionHandout Version


Objectives

• Summarize key frontline challenges to obtaining an accurate & efficient BPMH

• Characteristics of common areas of improvement

• Outline selected strategic solutions to overcome barriers to obtaining a BPMH

• Highlight practical tips & tools to support clinicians in obtaining the “golden” BPMH

• Highlight useful tools/forms on the Safer Health Care Now! Community of Practice (CoP)


• Patient Interview

• Labels on Rx Vials

• Medication Lists

• Family MD

Patient’s Actual Medication Use

• Medical chart

• Medication wallet cards

• Community pharmacist

Patient’s Medication Regimen Prescribed

What is the “truth”?

WHO HAS THE BEST MED LIST ?

Y. Kwan BScPhmY. Kwan BScPhm


What is a Best Possible Medication History ?

• A medication history obtained by a clinician which includes a thorough history of regular medication use (prescription and nonprescription)

• Uses information from: physician, patient or caregiver interview, inspection of prescription vials, community pharmacy follow-up, or current med list printed by community pharmacy

• What about a just a “quality” patient interview?

Jacqueline Wong BScPhm


Patient Factor Challenges

• Communication barriers

• Non – English speaking patients

• Level of consciousness/ cognitive impairment – post op/ acutely ill

• Solution: family members, interpreters, community pharmacy, BPMH prior to OR whenever possible

• Patient understanding of need to obtain an accurate medication history

• Solution: proactively explain importance, empower patient to actively participate


Patient Factor Challenges

• Poor perception of what is a medication? • Patients may not commonly list : OTCs, herbals,

vitamins, non-traditional , street drugs

• Solution: effective prompting/ follow/ up questions

• Poor Patient recall – complete list of medications or pharmacy name/ number:

• Solution: contact community pharmacy, www.canada411.ca proximity search (with street names)


System & Process Challenges

• Time/ Resources needed for a BPMH• Solution: Active Preparation: review other sources/

primary medication histories prior to interview to streamline process/ anticipate discrepancies

• Medication Use Medication prescribed• Solution: Focus on “medication use”

• Solution: Seek clarification : community pharmacy, primary care physicians, family


System & Process Challenges

• Accessibility - patients may not bring in medication vials/ lists to hospital

•Solution: Reminder prior to clinic visits; family ; contact community pharmacy

• Complexity of obtaining a comprehensive, accurate history

•Solution: anticipate skills required• Interviewing skills, knowledge base


10 Practical TipsObtaining a reliable and

accurate medication history

1. Prompt questions about unique dosage forms: eye drops , creams, inhalers, patches, sprays

2. Prompt questions about OTCs/ Vitamins / Herbals/ Non-traditional remedies

Example: Patient may not recall ASA

3. Inquire about changes from medication vials: dose changes/ stopped medications (patient or MD initiated)




4. Use medical conditions listed as a trigger

5. Assessing patient adherence/ compliance

• Inspect vials (? recently filled, be cautious of different contents)

6. Community pharmacy /contacts- anticipate/inquire about multiple pharmacies




7. Verifying accuracy –try to validate with at least 2 sources of information where possible

(patient history, vials, community pharmacy)

8. Be Proactive:

• Gather as much information as possible before seeing the client (primary histories, provincial database info, info from previous admissions)

• Readily accessible resources for consultation




9. Don’t assume patient is taking medications according to prescription vial label

• Open ended questions on medication use (how do you take this?)

• Inquire about why taking differently - ? Side effects ? Efficacy

10. Use a BPMH trigger sheet !! ( or another tool to guide a systematic process)


Medication History:Information Sources include…..

• Provincial drug data base

• Patient interviews

• MD chart notes

• Standardized forms

• Primary care physician records

• Inspection of Medication vials

• Review of community pharmacy records

• Review of hospital records (previous admissions)


Implementing Your Own Clinician Validation Program

• Part A: Interactive Learning/ Education Session

• Part B: Pre or Post Reading

• SHN! LTC Getting Started Kit

• Part C: Standardized Patient Validation Program


Sample: Interactive Learning/ Education Session

1. Patient Impact of Medication Discrepancies

2. Introduction to Medication Reconciliation

3. Conducting an Effective BPMH

4. Admission Reconciliation

5. Identifying & Coding Discrepancies


Implementing Your Own Clinician Validation Program

• Standardized Patient Validation Program• Part I: Obtain BPMH from a standardized patient –

actor (clinician provided feedback on process)• Props including: vials/ lists

• Feedback/ Score on accuracy- score sheet

• Feedback/ Score on process- score sheet

• Part II: admission reconciliation to identify discrepancies

• Part III: admission reconciliation coding of discrepancies

• Part IV: Feedback: Interactive discussion on areas of strength / improvement


Tools & Strategies on CoP

• BPMH guides/ trigger sheets

• BPMH Forms

• BPMH leading to admission order forms

• Instructional Videos

• Empowering patients as part of the BPMH process


Questions

[email protected]

Documents

© Institute for Safe Medication Practices Canada 2008® The 30 Minute BPMH Work Out: Tips, Tools and Strategies for Getting an Efficient and Complete Best