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adverse drug events which are defined as injury due to a medication are very common they affect approximately 10% of patients during hospitalization and 15% of patients during the first few weeks after hospital discharge errors in the medication history that healthcare providers take from patients are an important contributor to adverse drug events these errors account for up to 75% of all potentially harmful medication discrepancies in admission and discharge orders errors in the history can lead to patients receiving the wrong medications taking a good medication history is therefore not just a regulatory requirement it's important for improving medication safety during transitions of care the goal of a good medication history is to obtain complete information on the patient's regimen including the name of each medication the formulation the dosage route and frequency you should also distinguish between what patients are supposed to be on versus what they actually take a good medication history also ideally includes other aspects of the medication regimen such as indications for each drug it is helpful to know about any recent changes in the regimen including drugs that were recently stopped started or prescribed for a short course such as antibiotics over-the-counter drugs samples vitamins herbals and other products should be included ask when the patient last took each medication it's also important to note the patient's allergies and the associated reactions as well as their various prescribers and pharmacies taking the good medication history is not easy many healthcare professionals have not received training in how to take a good medication history compounding this patients may not be familiar with their medications and may not have a medication list available also available sources of information for example from the ambulatory medical record may be incomplete out-of-date or conflicting as a result errors in the medication history are common some examples include omitting a met vacation thinking that a patient is on a medication that she is not or documenting the wrong dosage or frequency the time it takes to obtain a good medication history can be a barrier as well but with proper training and practice providers can get both better and faster in taking an accurate history here are some tips on how to take the best possible medication history try to use at least two sources of information these may include interviewing the patient reviewing the patient's written medication list or obtaining information from family members or caregivers trying to verify information through the patient's medication bottles a medication list in the medical record or the pharmacy where the patient fills prescriptions is also helpful as you obtain information from different sources it's important to explore and clarify any discrepancies that you find using an available medication list for example from the outpatient medical record or a recent hospital discharge summary can save time and reduce errors in the medication history however medication lists often are not current or accurate the list may be incomplete or contain errors it is important to review and verify the list with the patient but don't just read the list to the patient and ask if it is correct instead you should start by asking the patient to tell you what they are taking or at least how much and how often they take each medicine on the list this increases your chances of finding inaccuracies in the list you have and also let you assess the patient's understanding of their medication regimen then use the list to explore discrepancies and confirm information finally you should probe to identify additional medications or products which may be absent from the list here are some suggested questions to help you obtain an accurate medication history whether or not you start with an available medication list begin with a simple open-ended question like what medicines do you take then ask about scheduled and PRN medications you can probe PRN drugs by giving common symptoms that may prompt medication use such as headaches allergies or insomnia then fill in the gaps for each medication elicit the dose and time of day the patient takes it if this information has not already been provided when appropriate asked about formulations such as extended release forms of diabetes and blood pressure agents and route of administration asking about the purpose of each medication provides information about patient understanding and may also lead to additional prompts for example asking if the patient takes anything else for that condition asking about medications for specific conditions that the patient has based on the patient's problem list also helps complete the medication list ask about medications that are easy to forget including those that are not taken orally are taken at night or are used at longer intervals such as weekly or monthly ask about non prescription products as well including vitamins assess when the patient last took a dose of certain medications particularly those that have a narrow therapeutic window like anticoagulants or affect key physiologic parameters like agents for blood pressure or diabetes ask about adherence in a way that is open-ended and non-judgmental that makes it okay for patients to admit their difficulties for example you could say many patients don't take their medicines exactly as they should every day and the last week how many days have you missed a dose of one of your medicines to save time and still take an accurate medication history use a medication list or the patient's pill bottles when they are available if you have a list in the medical record that agrees with a patient's list or bottles or if the patient seems reliable and can readily explain the differences you can complete the medication history fairly quickly a patient who can fluently describe the medication names doses frequencies and indications and is knowledgeable about recent medication changes is likely a reliable source of information it is not always necessary to get additional medication information from other sources however in a few situations you may need to contact the patient's pharmacy or provider or ask the family to bring in the medication bottle from home this could be important if the patient is unsure about medication names doses and indications when asked to verify an existing list or if the patient cannot explain discrepancies among medication lists gather additional data if the patient doesn't have a list and can't provide medication information reliably from memory this is important if the available medication list has not been updated recently the nature of the missing information should also be taken into account for example if the only unresolved piece of information is the dose of a cholesterol-lowering medication then it is not as urgent to call the pharmacy for confirmation but if the issue in question is the dose of insulin where any dose is possible and the risk of over or under treatment are high then it might be necessary to contact the pharmacy or outpatient providers office here is a short video that demonstrates the process of taking inaccurate medication history when a medication list is available mrs. Davis I'd like to go over your medications with you to make sure we have a correct list can't you just look on my records it should all be there actually I do have a printout of your medication list right here sometimes things change though and we may have information that's out of date this list is from a few months ago so I'd like to go over it with you if that's okay okay could you tell me what medications you take their strengths and when you take them I'll check them off the list as I go well in the morning when I wake up I take a represent eemiller grams and then there's also search Raeleen which is a hundred milligrams then there's synthroid and the blood pressure medication but I'm blanking on the name okay I've got the omeprazole here and the search Raeleen your medication list says you're taking the search Raeleen at night well I did at first but then I was having trouble sleeping so my doctor told me to take it in the morning instead and that helped out a lot okay good about the synthroid what dose are you taking I don't know it's a hundred something your list says 112 micrograms does that sound right yes that sounds right has anyone changed the dose of that medication recently no I've been on that medicine for a couple of years okay now what's the name of that blood pressure medicine I really can't remember I have am low to peen on your list does that sound correct yes that's it five milligrams yes okay so we've confirmed your MEP rizal sertraline centroid an EM load of pain is there anything else that you take isn't that it well actually I have a couple of other things on your list here do you take simvastatin it's a medication for cholesterol no but I used to I was having muscle aches and so my doctor switched me to something else and it starts with a P private statin yes that's it do you know the milligram dose yes 20 it was the same as the simba statin okay I also have trazadone on your list what's that it's a medication that some people take for depression or to help them sleep okay that must be the medicine that they gave me when I had trouble sleeping but I don't take that anymore changing a search early into the morning did the trick okay I'll scratch the trazadone off your list do you take any other medicines not that I can think of has anyone prescribed anything new for you in the last few months no do you take anything over the counter such as herbs vitamins supplements the cinnamon count cinnamon does count how much do you take I take two capsules a day anything else no that's it great we'll update your medication list and I'll give you a copy to keep here's another short video that demonstrates taking an accurate medication history when a medication list is not available mrs. Jen's next I'd like to go over your medications do you have your list or pill bottles with you no they're at home in that case can you tell me what medications you take sure I take a high blood pressure medicine two of those lisinopril and h2z and diabetes pills and then the doctors put me on a blood thinner about six months ago when I had my heart attack and then I take a cholesterol medicine at night I think that's it okay let me ask you about those you mentioned htz deeming H ctz we also call that hydrochlorothiazide yeah that's it I can't remember that long name okay well how much of that do you take it's 12 something it's half a 25 okay well how about the lisinopril do you know the strength of that one no it's been a long time I don't pay attention hmm would it be okay if I call your pharmacy to check on the dose sure I get it at Eric's Express on highway 90 okay I'll give them a call after we're done talking you mentioned diabetes pills how many different ones do you take oh there's just one well what's that called that's metformin I take it in the morning and in the evening can you tell me how much you take it each time two pills in the morning and two pills in the evening I don't suppose you know the strength to you I think it's 500 milligrams okay the next thing you mentioned was a blood thinner can you tell me the name of that it starts with a C but I can't think of the name of it is it committed I'm not sure well do you get your blood tested every few weeks to see how thin it is no I don't do that huh he's the medicine clopidogrel yeah that's it okay well that only comes in one dose 75 milligrams you mentioned a medicine for cholesterol which one is that it's something statin my doctor just switched that one she said my cholesterol wasn't under control and she wanted me to take a stronger one it's one that just went generic could it be a torta statin yes that's it I knew it started with an A it's ten milligrams okay so far here's what I've got HCT Z half a 25 milligram tablet lisinopril I'll check the dose with your pharmacy metformin 500 milligrams 2 pills in the morning and two in the evening clopidogrel 75 milligrams and atorvastatin 10 milligrams at night let me ask you to be sure when during the day do you take the H ctz with Santa Pro and clopidogrel I take all of those in the morning do you have any other medications not that I can think of unless you count the antibiotic sure tell me about that one uh well they gave me cipro for my bladder a couple days ago and told me to take it for three days and that's twice a day okay anything else no I think that's it let me run through a few other things just to be sure I saw the nurses nose he had asthma do you take anything for that yeah I have an inhaler I use it a couple times a day it's a steroid spray but I can't think of the name of it and I have albuterol but I don't need to take that very often do you take any other medicines from time to time only when you feel like you need them yeah I take a ibuprofen when my back hurts and they gave me those little nitro tablets but I don't need to take those how often have you needed to take the ibuprofen for the last week two or three times a day and what's the strength 400 milligrams and I take a couple at a time okay any other medicines that you take only when you need it like any medicines for headaches allergies or to help you fall asleep no do you take any medicines that you can buy off the shelf without a prescription well I get my baby aspirin and a big bottle from the warehouse store okay anything else you get from there yeah I get fish oil from there and I take one gram a day anything else any other nutritional supplements vitamins or herbal zhh no I think that's it so let me review again we've got h c TZ lisinopril metformin clopidogrel and atorvastatin you've got a steroid inhaler that he used twice a day and I'll butor all only when you need it you've been on cipro for the last couple of days you take ibuprofen is needed for back problems and lately you've been taking 800 milligrams two or three times a day you have nitroglycerin tablets but fortunately don't need to take them and you take fish oil every day does that cover it yes it's a lot isn't it yes it is a lot I know I'd have trouble keeping up with that many medicines I probably missed doses here and there and forget to refill my medicines on time tell me in the last week how many days have you missed a dose of one of your medicines several other techniques not shown in these videos can increase the accuracy of the medication history you can call the patient's pharmacy or pharmacies perform a brown-bag review of the patient's medication bottles or obtain information from family members pill identifiers like the one available on drugs.com can be helpful for patients who know the appearance but not the name of their medications or who bring in their pills but have removed them from the bottles let's review some take-home points taking an accurate medication history is important for reducing medication errors and adverse drug events unfortunately it's not easy and it can take time refer to a medication list when you can but be sure to review and verify it with the patient by using open-ended questions and specific prompts you can elicit a complete and accurate medication history you you