Transcript 10 BPMH Workout Olavo

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, FCSHP
Consultant, 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 Version
© Institute for Safe Medication Practices Canada 2008®
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)
© Institute for Safe Medication Practices Canada 2008®
WHO HAS THE BEST MED LIST ?
• Patient Interview
• Medical chart
• Labels on Rx Vials
• Medication wallet cards
• Medication Lists
• Community pharmacist
• Family MD

Patient’s Actual
Medication Use
Patient’s Medication
Regimen Prescribed
What is the “truth”?
Y. Kwan BScPhm
© Institute for Safe Medication Practices Canada 2008®
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
© Institute for Safe Medication Practices Canada 2008®
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
© Institute for Safe Medication Practices Canada 2008®
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)
© Institute for Safe Medication Practices Canada 2008®
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
© Institute for Safe Medication Practices Canada 2008®
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
© Institute for Safe Medication Practices Canada 2008®
10 Practical Tips
Obtaining 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)
© Institute for Safe Medication Practices Canada 2008®
10 Practical Tips
Obtaining a reliable and
accurate medication history
4.
Use medical conditions listed as a trigger
5.
Assessing patient adherence/ compliance
•
6.
Inspect vials (? recently filled, be cautious of
different contents)
Community pharmacy /contactsanticipate/inquire about multiple pharmacies
© Institute for Safe Medication Practices Canada 2008®
10 Practical Tips
Obtaining a reliable and
accurate medication history
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
© Institute for Safe Medication Practices Canada 2008®
10 Practical Tips
Obtaining a reliable and
accurate medication history
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)
© Institute for Safe Medication Practices Canada 2008®
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)
© Institute for Safe Medication Practices Canada 2008®
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
© Institute for Safe Medication Practices Canada 2008®
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
© Institute for Safe Medication Practices Canada 2008®
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
© Institute for Safe Medication Practices Canada 2008®
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
© Institute for Safe Medication Practices Canada 2008®
Questions
[email protected]
© Institute for Safe Medication Practices Canada 2008®