Medications at Transitions and Clinical Handoffs (MATCH) Toolkit for Medication Reconciliation

Tips for Conducting a Patient Medication Interview^a

I. Medication Information

To obtain or verify a list of the patient's current medications,^b you should inquire about:

• Prescription medications.
• Over-the-counter (OTC) drugs.
• Vitamins.
• Herbals.
• Nutraceuticals/Health supplements.
• Respiratory therapy-related medications (e.g., inhalers).

Full dosing information should be captured, if possible, for each medication. This includes:

• Name of the medication.
• Strength.
• Formulations (e.g., extended release such as XL, CD, etc.).
• Dose.
• Route.
• Frequency.
• Last dose taken.

II. Medication History Prompts

Incorporating various types of "probing questions" into the patient interview may help trigger the patient's memory on what medications they are currently taking. Here are some suggestions:

• Use both open-ended questions (e.g., "What do you take for your high cholesterol?") and closed-ended questions (e.g, "Do you take medication for your high cholesterol?") during the interview.
• Ask patients about routes of administration other than oral medicines (e.g., "Do you put any medications on your skin?"). Patients often forget to mention creams, ointments, lotions, patches, eye drops, ear drops, nebulizers, and inhalers.
• Ask patients about what medications they take for their medical conditions (e.g., "What do you take for your diabetes?").
• Ask patients about the types of physicians that prescribe medications for them (e.g., "Does your 'arthritis doctor' prescribe any medications for you?").
• Ask patients about when they take their medications (e.g., time of day, week, month, as needed, etc.). Patients often forget to mention infrequent dosing regimens, such as monthly.
• Ask patients if their doctor recently started them on any new medicines, stopped medications they were taking, or made any changes to their medications.
• Asking patients to describe their medication by color, size, shape, etc., may help to determine the dosage strength and formulation. Calling the patient's caregiver or their community pharmacist may be helpful to determine an exact medication, dosage strength, and/or directions for use.
• For inquiring about OTC drugs, additional prompts may include:
  • What do you take when you get a headache?
  • What do you take for allergies?
  • Do you take anything to help you fall asleep?
  • What do you take when you get a cold?
  • Do you take anything for heartburn?

^a Adapted from the Joint Commission Resources and the American Society of Health-System Pharmacists Medication Reconciliation Handbook. Chapter 5: Educating your staff. Oakbrook Torrance, IL: Joint Commission Resources, 2006.
^b For a full range of medications as defined by The Joint Commission, refer to their accreditation material.