11/13/24, 8\:11 PM Guide | Medication history

Medication history

Table of contents

Introduction

Lots of patients take multiple medications, prescribed by multiple professionals, in multiple settings. Often information
about these medicines is poorly transferred, therefore a structured approach to taking a medication history is essential.
This guide can be used to enhance any history that includes a drug history in an OSCE setting.

Opening the consultation

Wash your hands and don PPE if appropriate.
Introduce yourself to the patient including your name and role.
Con
Explain the reason for the consultation
Ask the patient if they currently have any concerns or questions about their medications. If the patient does have concerns, try
not to address them straight away, as without knowing the patient’s full pharmaceutical history you can not really know how
complicated their concern may be.
Example
" H e l l o , m y n a m e i s A d a m a n d I’ m t h e p h a r m a c i s t w o r k i n g o n t h e w a r d t o d a y .
"
" C a n I c o n
" I’ d l i k e t o a s k y o u s o m e q u e s t i o n s a b o u t y o u r m e d i c a t i o n , i s t h a t o k a y ?"
" B e f o r e w e s t a r t , d o y o u h a v e a n y c o n c e r n s a b o u t y o u r m e d i c a t i o n t h a t y o u’ d l i k e t o b r i n g u p ?"
" W e c a n c o m e b a c k t o t h a t i s s u e o n c e w e k n o w a l i t t l e b i t m o r e a b o u t y o u r m e d i c a t i o n h i s t o r y .
"

Currently prescribed medications

This section forms the foundation of the medication history. There are six key pieces of information you need to obtain about
each of the medications the patient is taking - sometimes referred to as 'the super six'
.
1. What is the medication? (drug name or characteristics)
This seems like a pretty obvious one but you’ll be surprised how often it gets missed. The pronunciation of drug names varies
greatly so you may need to think outside the box when the patient tells you they’re taking a product that you’ve never heard of.
Patients might also describe their medication based on colour, size, the shape of the actual formulation or the container (e.g.
" T h e l i t t l e r e d o n e s t h a t c o m e i n t h e b i g g r e e n b o x
" ).
2. What is the medication for? (indication)
Many drugs have multiple indications and the most common indication may not be the reason the patient is taking the
medication. Indications continually change with time as the results of new research becomes available. For example, at one
time, pregabalin was prescribed only to treat epilepsy, whereas now it is prescribed for neuropathic pain and generalised
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anxiety disorder. Medications can provide important collateral information about the patient's medical history. The patient may
not mention that they have pain or anxiety in their medical history but if they’re taking a medication indicated for these
conditions, this may provide a clue which you can explore further.
3. How much (or how many) of the medication do you take?
When asking patients for information about their medication, it is important to remember they may not think about doses in
terms of milligrams or micrograms but rather one or two tablets, spoonfuls, capsules, pu
‘strong’ the medication is as sometimes patients will describe the dose of their medications this way.
4. How often do you take the medication?
This question provides two useful bits of information. Firstly it provides you with information about the full dosing regimen by
providing the frequency (e.g. the patient takes one pink capsule three times a day). It also provides some information about the
patient's adherence to their treatment; the patient may say
" I o n l y t a k e i t n o w a n d a g a i n" or " I m a k e s u r e t o t a k e t h i s m e d i c a t i o n
e v e r y d a y
"
. Non-adherence or medication overuse may be relevant to the patient's presenting complaint.
5. When did you begin taking the medication?
Knowing how long the patient has been taking a medication is important, as this in
Type A pharmacokinetic e
Type B pharmacodynamic e
Type C statistical e
time (e.g. gastric ulceration with NSAIDs)
6. How do you take the medication?
Medication can behave di
more slowly than medication taken on an empty stomach, or a medication that is taken with milk (or close to breakfast) can
chelate and not be absorbed at all. This question should also help you identify if the patient is using a multiple-compartment
compliance aid ('MCCA'
, a.k.a. a dosette box, tray, NOMAD, pillbox) which, if not identi
hospital. This question will also help you to clarify what formulation the medication is (e.g. liquid, capsules, inhaler or
subcutaneously injected etc). If issues are identi
how to take the medication appropriately (e.g. inhaler technique).
After gathering this information you should summarise your
gathered is correct.
You should ask the super six about each and every medication that is prescribed for the patient. You may notice that some
patients will start to readily volunteer the information as they predict which question is coming next. Make sure to give the
patient plenty of time to answer and try not to interrupt them.
Example
" I’ d l i k e t o
"
1.
" W h a t i s t h e m e d i c a t i o n ? W h a t d o y o u c a l l t h e m e d i c a t i o n y o u t a k e ?"
2.
" W h a t i s t h e m e d i c a t i o n f o r ? W h y d o y o u t a k e t h a t o n e ?"
3.
" H o w m u c h ( o r h o w m a n y ) o f t h e m e d i c a t i o n d o y o u t a k e ?"
4.
" H o w o f t e n d o y o u t a k e t h e m e d i c a t i o n ?"
5.
" W h e n d i d y o u b e g i n t a k i n g t h e m e d i c a t i o n ? H o w l o n g h a v e y o u b e e n t a k i n g t h a t ?"
6.
" H o w d o y o u t a k e t h e m e d i c a t i o n ? O n a t y p i c a l d a y , h o w w o u l d y o u t a k e t h a t o n e ? W i t h f o o d , " O k a y , j u s t t o s u m m a r i s e , y o u t a k e [ p r e ga b a l i n ] f o r [ a n x i e t y ] , [ o n e c a p s u l e ] [ t h r e e t i m e s a d a y ] . y e a r s ] a n d y o u t a k e i t [ r e g u l a r l y , o n a n e m p t y s t o m a c h ] . I s t h a t r i g h t ?"
*Repeat for each prescribed medication*
o r o n a n e m p t y s t o m a c h ?"
Y o u h a v e b e e n o n i t f o r [ 6

Non-prescribed medications

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After asking about prescribed medications, it’s important to check that the patient doesn’t take anything else that is not
prescribed which they have purchased over-the-counter or, increasingly, from the internet for self-care.
This could include supplements, vitamins, and herbal or homoeopathic remedies.
This is an important part of taking a medication history, as many of these products will in
pharmacokinetic properties of prescribed medication. For example, St John’s Wort can increase the metabolism and therefore
reduce the e
It is important to ask the patient where they source their non-prescribed medications. If the products are purchased from a
pharmacy, it is likely the product is what it says it is. However, if purchased online or from overseas, the patient may be using a
poor quality product. If this is the case, you should ask to see the product and ask the senior pharmacy team for support,
particularly if the pathology of the presenting complaint is unclear.
Example
" D o y o u t a k e a n y t h i n g t h a t y o u b u y f r o m a s u p e r m a r k e t o r o v e r t h e i n t e r n e t ?"
If yes, use the super six to

Extra medications

When asking about prescribed and non-prescribed medication, patients often forget to mention products that they may not
classify as medications, such as eye drops, inhalers, sprays, patches or creams. However, many of these products contain
pharmacologically active ingredients that can cause or exacerbate medical conditions.
Example
" D o y o u t a k e a n y e y e d r o p s , e a r d r o p s , i n h a l e r s , s p r a y s , p a t c h e s , i n j e c t i o n s , c r e a m s o r o i n t m e n t s ?"
If the patient says they take any of those, use the super six to obtain a thorough history.

Allergies & side e

Ask if the patient has any drug allergies and clarify what happens when the patient takes the medication. Make sure to
document allergies clearly in the patient's record.
" D o y o u h a v e a n y a l l e r g i e s t o m e d i c a t i o n s ?"
" W h a t h a p p e n e d w h e n y o u e x p e r i e n c e d t h e a l l e r gi c r e a c t i o n ?"
Explore if the patient is experiencing any signi
" A r e y o u c u r r e n t l y e x p e r i e n c i n g a n y s i d e e

A patient’s social history can provide useful information when reviewing their pharmaceutical care. For example, smoking
tobacco induces enzymes that speed up the metabolism of theophylline and changes in vitamin K consumption can reduce
the e
such as cannabis or ecstasy.
Asking questions about the patient's lifestyle will also provide collateral information about their treatment adherence. For
example, someone who leaves at 5 am for a 90-minute commute to work is unlikely to want to take their Furosemide
in the morning. Additionally
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prescribing decisions.
Example
“ I’ m g o i n g t o a s k y o u s o m e q u e s t i o n s a b o u t y o u r l i f e s t y l e n o w , i s t h a t o k a y ?”
" T a l k m e t h r o u g h a t y p i c a l d a y , f r o m w h e n y o u w a k e u p t o w h e n y o u go t o b e d a n d h o w y o u r m e d i c a t i o n s
Listen carefully to the patient's response. Use the questions below to help clarify any missing information.
Occupational history
Ask the patient what their occupation is\: this may be relevant when considering the practicalities of when a patient is going to
be able to take their medication. Some jobs involving the operation of heavy machinery or driving may restrict the types of
medication a patient is able to take if they want to continue these tasks.
" D o y o u w o r k ?"
" W h a t' s y o u r j o b r o l e a n d w h a t d o e s i t i n v o l v e ?"
" W h a t i s y o u r s h i f t p a t t e r n l i k e ?"
Support at home
Explore the patient's social context to clarify if they have any support at home who could assist with the administration of
speci
" D o y o u h a v e a n y h e l p w i t h y o u r m e d i c a t i o n s a t h o m e ?"
" I s t h i s f r o m c a r e r s o r y o u r f a m i l y ?"
Smoking history
Record the patient’s current and past smoking history, including the type and amount of tobacco used.
" D o y o u s m o k e a n y t o b a c c o ?"
" H o w m a n y c i g a r e t t e s d o y o u s m o k e a d a y ?"
" H o w l o n g h a v e y o u s m o k e d f o r ?"
Alcohol history
Record the frequency, type and volume of alcohol consumed on a weekly basis.
See our alcohol history taking guide for more information.
" D o y o u d r i n k a n y a l c o h o l ?"
" H o w o f t e n d o y o u d r i n k a l c o h o l a n d h o w m u c h d o y o u t y p i c a l l y d r i n k e a c h t i m e ?
Recreational drug use
Ask the patient if they use recreational drugs and if so determine the type of drugs used and their frequency of use.
" D o y o u u s e a n y r e c r e a t i o n a l d r u g s ?"
" W h i c h d r u g s d o y o u u s e a n d h o w f r e q u e n t l y d o y o u u s e t h e m ?"
Diet and exercise
Ask if the patient what their diet looks like on an average day.
Ask if the patient regularly exercises and if so clarify the frequency and activity type of exercise.
" W h a t d o e s y o u r d i e t l o o k l i k e o n a n a v e r a g e d a y ?"
" D o y o u d o a n y e x e r c i s e ?"
" W h a t t y p e s o f e x e r c i s e d o y o u d o a n d h o w o f t e n ?"
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Providing information

Identifying the pharmaceutical care issue

At this stage of the consultation, you should revisit any concerns the patient may have about their current medication regime.
It’s also important to provide the patient with the opportunity to raise any additional concerns about their medication.
If you have identi
used correctly, you should raise them for discussion with the patient in this part of the consultation. The patient will be able to
o
If a patient is unwilling to change the way they use a particular medication and you feel that they’re at high risk of signi
harm then you can say something like " I’ m g o i n g t o h a v e t o s t o p t h a t m e d i c a t i o n b e c a u s e …
"
Example
" Y o u m e n t i o n e d y o u w e r e c o n c e r n e d a b o u t …. i s t h e r e a n y t h i n g e l s e y o u’ r e c o n c e r n e d a b o u t ?"
" S o m e t h i n g I’ m c o n c e r n e d a b o u t i n r e l a t i o n t o y o u r m e d i c a t i o n i s t h a t …
"
"
... y o u m e n t i o n e d t h a t y o u t a k e y o u r i b u p r o f e n w i t h o u t f o o d .
"
"
... y o u m e n t i o n e d t h a t y o u m i s s y o u r i n s u l i n n o w a n d a ga i n .
"
"
... y o u m e n t i o n e d t h a t y o u c r u s h y o u r m o d i
"
" I’ m c o n c e r n e d a b o u t t h i s b e c a u s e …
"
"
...w h e n y o u t a k e i b u p r o f e n t h a t w a y i t c a n u p s e t y o u r t u m m y a n d c a u s e u l c e r s .
"
"
...w h e n y o u m i s s i n s u l i n i t c a n c a u s e p r o b l e m s f o r y o u r d i a b e t e s .
"
"
...w h e n y o u c r u s h y o u r c a r b a m a z e p i n e i t m a y n o t w o r k a s e
"
" W o u l d y o u b e i n t e r e s t e d i n c h a n g i n g t h e w a y y o u u s e t h a t m e d i c a t i o n ?"

Propose a plan of action

The action plan will depend greatly on the patient’s perspective. They may be unwilling to change too many medications at
once because it will disrupt their routine or they may be fearful that their medical condition might worsen.
Pharmaceutical management plans may include any of the following points\:
No changes to the current regime
Reduce/increase dose
Withhold a medication temporarily
Additional therapy to deal with a side e
Referral to a specialist pharmacist, medical consultant, GP or nurse if you have reached your level of competence and
require additional input
Plans should include short-term and long-term outcomes.
Short-term plan\:
The goal?
Who will do what?
Over how long?
Any monitoring required?
Long-term plan\:
Who will do what?
Over how long?
Any monitoring required?
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Example
" O k a y , s o i n t h e s h o r t-t e r m , w e w o u l d l i k e t o r e d u c e y o u r d o s e o f d i a z e p a m a s y o u f e e l l i k e i t i s m a k i n g y o u t o o d r o w s y .
"
" L e t’ s c h a n g e y o u r d o s e f r o m t o m o r r o w s o y o u t a k e 5 m g l e s s .
"
" S o f o r t h e n e x t t w o w e e k s , y o u w i l l o n l y t a k e o n e d i a z e p a m t a b l e t e a c h d a y .
"
" I w i l l g i v e y o u a c a l l i n t w o w e e k s t o s e e h o w y o u’ r e ge t t i n g o n . I s t h a t o k a y ?"
" I n t h e l o n g-t e r m , I t h i n k t h e r e s t o f y o u r m e d i c a t i o n i s o k a y .
"
" W e c a n a s k t h e G P t o r e v i e w e v e r y t h i n g a ga i n i n s i x m o n t h s .
"
" I d o n’ t t h i n k w e n e e d a n y a d d i t i o n a l m o n i t o r i n g o r t e s t s d o n e a t t h i s p o i n t f o r a n y t h i n g . I s t h a t o k a y ?"

Closing the consultation

When closing the consultation it’s a good idea to summarise the key points, including the information on the currently
prescribed medication, the non-prescribed and the extras to make sure nothing has been missed. You should also summarise
the short term and long term plan so the patient understands it fully and give the patient a
questions about what has been covered.
Dispose of PPE appropriately and wash your hands.
Example
" O k a y , s o w e’ v e d i s c u s s e d y o u r m e d i c a t i o n w h i c h i n c l u d e d [ t w o i n h a l e r s , y o u r m e d i c a t i o n f o r a n x i e t y , p a i n , d i a b e t e s ,
e p i l e p s y a n d t h e v i t a m i n s y o u b u y o v e r t h e c o u n t e r ] . T h e p l a n i s t o r e d u c e y o u r d i a z e p a m b y o n e t a b l e t e a c h d a y a n d I’ m
g o i n g t o c a l l y o u i n t w o w e e k s t o s e e h o w y o u f e e l t h a t i s g o i n g a n d t h e n r e v i e w e v e r y t h i n g e l s e a ga i n a t y o u r u s u a l
r e v i e w a p p o i n t m e n t w i t h t h e G P s u r g e r y .
"
" D o y o u h a v e a n y q u e s t i o n s a b o u t w h a t w e’ v e c o v e r e d i n t h i s c o n s u l t a t i o n ?"
" D o y o u h a v e a n y q u e s t i o n s a b o u t a n y t h i n g w e h a v e n’ t c o v e r e d t h a t I m a y b e a b l e t o h e l p w i t h ?"
" I f y o u t h i n k o f a n y t h i n g a f t e r w a r d s , m y n a m e i s A d a m a n d y o u c a n ge t i n t o u c h w i t h m e b y a s k i n g t h e n u r s e s t o c o n t a c t
p h a r m a c y / c a l l i n g m e o n 1 2 3 4 5 6 7 8 9 1 2"
" T h a n k y o u
"

After the consultation

The patient is the most valuable source of information in relation to their medication - they’re the ones who ultimately take
them. However, if possible, you should try and obtain a collateral history from another source to con
Some sources you may want to consider using include\:
GP records
Hospital records
Patient’s copy of their repeat prescription
The actual products\: some patients bring their medication to consultations or hospitals in a green bag which makes it much
easier to check doses. Be wary that this medication is actually the patients and not their partner's.
Care home medication administration record
Community pharmacy
Family members or carers
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Following the consultation, you should try and record the information in the patient's notes, including what sources you used. It
may be possible to add this to the patient's current prescribed medication if you’re using an electronic prescribing system or
you may have to free-type or write out the information directly into the patient's paper notes. This can be time-consuming but
try not to rush - many signi
incorrectly. Take your time and double-check that what you have documented is what you intended.
If you’re free typing/handwriting in paper notes, try and include the super six pieces of information for each medication as a
minimum as well as your short and long-term plan of action.

References

1. Abdel-Tawab R, James DH, Fichtinger A, Clatworthy J, Horne R, Davies G. Development and validation of the Medication-
Related Consultation Framework (MRCF). Patient Education and Counseling. 2011;83\:451-457.
2. Kurtz S, Silverman J, Benson J, Draper J. Marrying Content and Process in Clinical Method Teaching\: Enhancing the Calgary–
Cambridge Guides. Academic Medicine. 2003;78\:802-809.
3. Centre of Pharmacy Postgraduate Education. Consultation skills for pharmacy practice\: taking a patient-centred approach.
University of Manchester\: Manchester. 2014.
4. Nickless G, Davies R. How to take an accurate and detailed medication history. The Pharmaceutical Journal. 2016.
5. Krska J, Cromarty J, Arris F, Jamieson D, Hansford D. Providing pharmaceutical care using a systematic approach. The
Pharmaceutical Journal. 2000;265\:656 - 660.
Source\: geekymedics.com
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