Home' News Bulletin : ADA News Bulletin August 2015 Contents 41
How to take a better
Medication history-taking is an important skill for dentists,
not only for optimising patient care, but also because it is a
requirement for dental practice accreditation. I've been giving
talks around the country to dental groups about how to take a
medication history. Wherever I go, the session starts with people
saying "oh, yes, we do this well already" but by the end most
discover they could be documenting medications somewhat better
than they currently do.
You can find reference to the requirement for medication history-
taking in the current edition of the National Safety and Quality
Health Service (NSQHS) Guide for Dental Practices and Services from
the Australian Commission on Safety and Quality in Health Care.1
Standard 4 of this guide for dental practice accreditation is entitled
Medication Safety. Standard 4.6 within this standard relates to
medication history taking and section 4.6.1 states: "A best possible
medication history is documented for each patient".
Best Possible Medication History is defined as:
"An accurate recording of a patient's medicines. It comprises a list
of all current medicines including prescription and non-prescription
medicines, complementary healthcare products and medicines used
intermittently; recent changes to medicines; past history of adverse
drug reactions including allergies; and recreational drug use".
So here's the first area for improvement. In addition to
documenting the patient's prescription medicines, their non-
prescription, complementary and 'prn' medicines should be
listed as well. Important drugs here are pain relievers especially
NSAIDs and codeine, antihistamines and cough/cold remedies.
Some practitioners do record complementary medicines but most
just name the active ingredient e.g. "fish oil" or "glucosamine",
whereas you really need the product name to know exactly what
the patient is taking, e.g. Blackmores Macuvision Plus.
A best possible medication history should also document the dose
of each medication, how long the patient has been on it and its
purpose. I'm sure you can appreciate the value of these details
for clinical decision making. For example, there's a big difference
between just knowing a patient is on prednisone compared with
knowing they're on prednisone 60 mg daily for one week for
acute polymyalgia rheumatica. It tells you so much more of the
There are several understandable reasons why these extra details
are often not collected. Firstly, there is no prompt on the medical
history form for these details and secondly, there's insufficient
room for them anyway. Some practices I've been working with
have developed entirely separate forms for their medication
history-taking and are very pleased with how much extra
information they are gathering this way.
Thirdly, we rely too heavily on patients' memory. Few people
can list all their medicines off-by-heart, let alone their dose and
duration. All patients on polypharmacy should be advised to carry
a comprehensive list of their medicines in their wallet or by using
a phone app such as MedAdviser. Some may even have access
to their electronic health record, but we all know these patients
remain the exception rather than the rule.
One final issue I see is an element of blind faith in a GP-provided
medicines lists. I'm not saying GP lists are a bad thing, but they are
rarely 100% accurate or up-to-date. This is because a GP list rarely
• Medicines ordered by other doctors or health professionals e.g.
• Non-prescription medicines from pharmacies and supermarkets
• Complementary medicines eg. vitamins, herbal remedies,
• Medicines purchased over the Internet e.g. Viagra
• Borrowed medicines e.g. from one's spouse
There is also a tendency for GP lists to include drugs that have
been stopped or courses completed without marking them as
ceased, so the GP can keep a record of their use e.g. antibiotics.
Basically, any single source of medication history is likely to have
flaws. To overcome this problem, pharmacists who specialise in
this area engage in a process called Medication Reconciliation
whereby the medication history from the first source is reconciled
with a reliable second source. So if the history comes from the GP,
it is verified with the patient or their carer. Other sources could be
the patient's pharmacy, or the medication themselves.
The bottom line is an ideal medication history should document
the name of every medicine the patient takes, its dose, duration
and purpose. It would be great if more dental practices could
document medicines this way and easier for me to answer your
References supplied are available on request from firstname.lastname@example.org
Links Archive ADA News Bulletin July 2015 ADA News Bulletin September 2015 Navigation Previous Page Next Page