FINALS
DISPENSING 1
PHARM 213
UNIT 1: PATIENT MEDICATION PROFILE
OUTLINE
PARTS OF A PX MEDICATION PROFILE
RELEVANCE OF PX MEDICATION PROFILE
TO THE PHARMACY PRACTICE
INTRODUCTION
During the old practice, pharmacists tend to rely on
other health care professionals to obtain and
document information regarding medications taken by
patients. Pharmacists had limited direct patient care
responsibility and did not need firsthand knowledge of
patient medication use. Today, the medication history
is the foundation for planning optimal patient-specific
medication regimens. The medication history
magnifies the role of medications in the treatment of
disease; the patient’s ability to comply with the
medication regimen; the medication’s effectiveness;
and the patient’s experiences with side effects,
allergies, and adverse drug reactions.
Pharmacists have a unique combination of drug-
related expertise and experience; patients trust and
respect pharmacists. Although other health care
professionals interview patients regarding their use of
medications, no other health care professional has the
pharmacist’s depth and scope of knowledge regarding
medications. Therefore, it is important that
pharmacists obtain and document patient medication
profiles and communicate this information to the rest of
the health care team.
Other health care professionals often lack important
information regarding medication allergies and
sensitivities, prescription and nonprescription
medication use, use of alternative remedies,
immunizations, and reliability in taking scheduled
doses.
A meta-analysis of 22 studies of physician-obtained
hospital admission medication histories found that
10% to 67% of the medication histories had at least
one prescription medication error; the error rate when
non-prescription drugs were included ranged from
27% to 83%, and the error rate when drug allergies or
prior adverse reactions were included ranged from
34% to 95%.4 Take note that incomplete patient
profiling may put the patient at risk due to interrupted,
unnecessary, duplicative and incorrect therapy.
BONITE, J.
Medication history is the first step in the medication
reconciliation process. Medication reconciliation is the
process of comparing the patient’s preadmission
medications with the medications prescribed during
the hospitalization. It is intended to prevent
medication-related patient safety problems such as
errors of omission and duplication as well as drug-drug
and drug-disease interaction errors. Successful
medication reconciliation depends on obtaining an
accurate and complete medication history at the time
of admission to the hospital. Medication reconciliation
is intended to improve patient safety while the patient
is hospitalized and at discharge.
PARTS OF A PATIENT MEDICATION PROFILE
Patient medication profiles are necessary especially
for hospital pharmacists to monitor inpatient
medication therapy. The medication profile gives the
pharmacist an opportunity to actively participate in
monitoring patient care. The form used in profiling is
designed locally but may vary from one hospital to
another. Take note that the data obtained should be as
complete and descriptive as possible. The following
are the common information seen in a patient
medication profile:
DEMOGRAPHIC INFORMATION
This includes the patient’s age, height, weight, race or
ethnic origin, education and/or occupation.
Example: The patient is a 61-year-old white male
(DOB 7/15/48). Height 5′10′′. Weight 216 kg. He lives
with his wife in a rented one-story house. He is an
unemployed truck driver.
CHIEF COMPLAINT
This is the reason why the patient is seeking medical
care. The CC is presented and documented in the
patient’s own words, which provides a sense of the
patient’s experiences and understanding of the
problem and conveys the patient’s perception of the
urgency and severity of the problem.
Example: “I can’t breathe properly when I lay on my
back.”
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 UNIT 6: PATIENT MEDICATION PROFILE
HISTORY OF PRESENT ILLNESS
It is a narrative that describes the story of the current
problem. All characteristic details, such as the specific
symptoms, how the problem began or was first
recognized, the duration of symptoms, test results
from previous evaluations for the same problem,
activities and treatments that ease and worsen the
problem, and past experiences with the problem, are
included in the HPI.
Example: The patient has an 8-year history of COPD,
a 5-year history of hypertension, and a 6-month history
of atrial fibrillation. He was last seen in clinic 1 month
ago when his COPD medications were modified. He
states that his breathing is improved, with less SOB
and DOE. He denies fevers, chills, sweating, nausea,
vomiting, and diarrhea.
Past Medical History
The past (or prior) medical history (PMH) includes a
brief description of patient problems unrelated to the
present illness.
Example: Mild to moderate hypertension for 10 years;
type 1 diabetes mellitus for 5 years; glaucoma for 25
years; S/P tonsillectomy and adenoidectomy age 7.
SOCIAL HISTORY
Social habits include the use of tobacco, alcohol, and
illicit drugs. Illicit drug use may be difficult to ascertain.
Obtain this information in a professional,
nonthreatening, nonjudgmental manner.
Example: The patient is a non-smoker and does not
currently drink alcohol but previously was a heavier
drinker, drinking one six-pack of beer per day for 10
years; his last drink was 1 year ago. The patient used
marijuana two or three times 10 years ago
CURRENT MEDICATIONS
Obtain a complete list of the patient’s current
medications, including the name and dosage of the
drug, dosing schedule (prescribed and actual),
duration of therapy (start date), reason the patient is
taking the medication, and outcome of therapy.
Knowledge of current prescription medications allows
the pharmacist to evaluate the efficacy and safety of
prescribed regimens.
Example: Patient is taking hydrochlorothiazide
(Esidrex) 50 mg daily for 5 years now for her high
blood pressure. The patient reports that her blood
pressure has been well controlled with this regimen.
BONITE, J.
PAST MEDICATIONS
Obtain as much information about past medications as
possible, including name and description, dosage,
prescribed and actual dosing schedule, dates and
duration of therapy, reason for taking the medication,
and outcome. Knowledge of past prescriptions helps
the pharmacist understand the medications used,
either successfully or unsuccessfully and to treat
current and past medical problems. This knowledge
guides recommendations regarding new medication
regimens.
Example: The patient was diagnosed with
hypertension 5 years ago. He initially took
hydrochlorothiazide 25 mg daily and enalapril 5 mg
daily for 3 years.
DRUG ALLERGIES
The term allergy indicates hypersensitivity to specific
substances. Drug-induced allergic reactions include
anaphylaxis, contact dermatitis, and serum sickness.
Ask patients whether they are allergic to any
medications and then probe for the details of the
problem, depending on the response
Example: The patient is allergic to penicillin. The
patient had an itchy rash over his whole body after
taking a couple of doses of penicillin 2 years ago.
PHYSICAL EXAMINATION
Presentation of the physical examination (PE) findings
begins with a short description of the patient. The
patient description helps the healthcare team to
visualize the patient and begin to anticipate pertinent
findings. The patient’s vital sign values, including the
blood pressure and heart rate, respiratory rate, and
temperature, follow the initial description of the patient.
Example: Patient A is a pleasant, cooperative 48-
year-old African American female in no apparent
distress. Vital signs: BP 120/84 mm Hg, HR 80
beats/min (irregularly irregular, normal strength), RR
12 breaths/min, afebrile.
LABORATORY AND/OR DIAGNOSTIC RESULTS
Results from laboratory and diagnostic tests and
procedures are presented after the physical
assessment section of the patient case. The amount of
detail included in the laboratory and diagnostic result
section depends on the severity and complexity of the
patient’s medical problem.
Example: Sodium 140 mEq/L, potassium 4.1 mEq/L,
chloride 101 mEq/L, blood urea nitrogen 10 mg/dL,
etc.
DIAGNOSIS AND MANAGEMENT
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 UNIT 6: PATIENT MEDICATION PROFILE
RELEVANCE OF PATIENT MEDICATION PROFILE
TO THE PHARMACY PRACTICE
Patient medication profile allows the pharmacist to
review all the medications that a patient is taking
before dispensing the first dose and with each new
medication order.
Problems with pharmaceutical therapy, such as
allergies, duplicate therapy, medicine-medicine
interactions, medicine- disease interactions,
inappropriate length of therapy, and inappropriate
dosing, can be detected and avoided or corrected
BONITE, J.
Nowadays, computerized pharmacy systems display
the patient’s medication profile on the screen, and the
pharmacist edits the screen with each new order.
Medication interactions, dosage ranges, and other
monitoring functions can be programmed into the
computer.
In developed countries, information technology
advances now provide linkages to patient-specific
information from laboratory and clinical monitoring.
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