Module 1-medication, History -Taking Flashcards
BID
Twice a day
BPMH
“ best possible” medication history
CI
Confidence interval
ED
Emergency department
EHR
Electronic health record
HD
Hospital day
MRA
Medication, reconciliation assistance
med rec
Medication reconciliation
PAML
Pre-admission medication list
PO
My mouth
RCT
Randomized controlled trial
RN
Registered nurse
The majority of potential harmful medication discrepancies in hospital order are due to errors
In :
Medication history-taking
In recent studies, such as a book key, MARQURIS2, the receipt of patient level interventions, such as a “BPMH,” can result in how large of a reduction in medication discrepancy in admission and discharge orders? 

60%
Medication reconciliation errors in control group of partner RCT
Potential for harm 27%
History error 72%
Reconciliation error 30%
1- BPMH
2-reconciliation at discharge
3-patient counseling.
4-forward information to next provider.
Medication reconciliation bundle:
Risk assessment :
-intense vs. Standard bundle depending on patient risk.
Intervention components :
1-medication reconciliation bundle.
2-risk assessment.
3-train providers in taking a BPMH and in performance discharge counseling
4-improving access to pre-admission medication sources.
5- other the risk, high reward interventions
Improving access to pre-admission medication sources:
-Encouraging patient all medication list.
-Facilitating assess to other medication sources example pharmacy
Other high risk, high reward interventions
-Implementing and improving health information technology
-utilizing social marketing.
-Engaging community resources
Why is this hard?
-Information system that don’t talk to each other.
-Lack of single “ source of truth”
-Fragmented healthcare system
-many transition care
-Lack of communication between patient and providers( and
among providers)
-Patient who may not be engaged in their own healthcare, have low health literacy,
-few social support.
-
Why is this hard?
-poly pharmacy,
-frequent changes in regiment,
-lack of value place on medication reconciliation.
Best possible medication history barriers:
-We need an army of trained, competent, upper BPMH -takers
-That’s why you are here
Conclusions:
error in medication history taking are the most common cause:
-error in medication history taking are the most common cause:
1-of unintentional medication
2-, discrepancy in admission and
3- order in hospital
