Clinical Pharmacy

1. MEDICATION HISTORY
INTERVIEW

2. INTRODUCTION
 Patient Medication history interviews help the pharmacist to
establish rapport with the patient, commence preliminary
counselling and help to devise an ongoing pharmaceutical care
plan
Sources: Patient, medication records from the hospital and other
sources.

3. Goals
 To gather information to be utilised to
 Compare medication profiles with the medication
adminstration record and investigate discrepancies
 Verify medication histories taken by other staff and provide
additional information where appropriate
 Document allergies and adverse reactions
 Screen for drug interactions assess patient medication
compliance
 Assess the rationale for drugs prescribed
 Assess for evidence of drug abuse
 Appraise drug administration techniques
 Examine the need for medication aids
 Document patient-initiated medication administration

4. DOCUMENTATION
Documentation of medication history include
 Current medication administration record
 Previous prescriptions
 Current admission details
 Referral letter from local doctor or other sources
 The patient’s own medication list

5. PREPARING FOR THE INTERVIEW
• Determine specific goals of the interview
• Establish the identity of the patient
• Introduce yourself
• Explain the purpose of the interview
• Respect the patient’s right to decline an interview
• Adopt a suitable physical position to enable the interview
to take place comfortably and effectively
• If the patient is not in a position to manage the care, the
interview should be done with the relevant person

6. Information to be obtained in the
Interview
 Prescription medication use
 Non-prescription medication use
 Allergies, previous adverse drug reactions and their
manifestations
 Use of alternative therapies
 Social drug use (eg. Alcohol, smoking)
 Illicit drug use
 Immunisation status
 Community pharmacies and general practice surgeries
visited

7. Seeking Specific Information
 The patient’s perception of the purpose and effectiveness of the medication(s)
 The dose and dosage schedule used
 The duration of the therapies used
 The perceived effectiveness of the medication(s)
 A general impression of the likelihood that the patient has the medication(s) as
prescribed
 The reasons for discontinuation or alteration of medications
 The storage of medications
 Any problems with the medication therapy
 Conclusion
 Summarise the important information
 Answer patient’s questions regarding therapy
 Encourage the patient for further information

8. Follow-up
 Comparison of medication profile with medication
administration record
 Identify and resolve drug related problems
 Counsel the patients about alterations to their medications