Introduction
As a dentist, and an expert in the healthcare field, taking a comprehensive medication history is an important step in providing high quality care for your patients. Using the methods described here they should only take you 5 minutes to complete!
Consequences of Poor Medication History
Before we get started, it is important to know the consequences of taking poor medication histories. Let’s look an example of when a patient is taking a non-selective beta blocker and epinephrine is given in the dental setting.
Consider this scenario:
A patient visits a dental clinic and requires a local anesthetic with epinephrine for a dental procedure. The patient fails to disclose their current medication, propranolol, which is non-selective beta blocker.
Non-selective beta-blockers like propranolol significantly enhance the pressor response to epinephrine. The mechanism involves blockade of beta-2 adrenergic receptors in the peripheral vasculature, resulting in unopposed alpha-adrenergic effect of epinephrine that is responsible for vasoconstriction.
The result: the patient experiences a hypertensive emergency, characterized by severe headache, shortness of breath, chest pain, dizziness, palpitations, and even organ damage. A real scare for the patient and the dentist.
Without knowing the patient’s medication history, the dentist could not have foreseen this interaction. While not always as severe, adverse reactions and interactions like this happen all too often in dental clinics due to a lack of transparency between patient and dentist.
In this new era of healthcare, I hope to bridge the gap between patients and dental professionals and bring dentistry forward as the gold standard of primary patient care.
So let’s get started by taking exceptional medication histories!
Gathering Medication Information
The first step to taking a comprehensive medication history is to gather information about the patient’s current medications. This includes prescription medications, over-the-counter medications, and herbal supplements. What I have found to be helpful as a pharmacist is asking the patient to bring a list of their medications or their medication bottles to their appointment.
Unfortunately, patients often don’t have a list of their medications, or they don’t think that it is necessary for the provision of safe dental care. This misconception on the part of patients can sometimes lead to you, the dentist, not being able to provide optimized care.
In this circumstance, you can use PharmaNet to look up their medications. In BC Canada, PharmaNet is a secure network that connects pharmacies and health care providers to a patient’s medication information. Dentists were recently approved for access and can view the system through registration and electronic setup.
Read our recent article on How to Set Up PharmaNet here if you don’t yet have access!
By using PharmaNet, you can confirm what medications the patient is taking, check dosages and regimens, and check for potential drug interactions, all in a short amount of time.
Avoiding Medication Misinformation
Always be sure to confirm medications (that are listed on PharmaNet or on a medication list) with your patient. PharmaNet only documents if the medication was filled by a pharmacy, and God only knows what is written on that crumpled up piece of paper that was updated five years ago. These lists do not guarantee that the patient is still taking the medication, or that they are taking it as prescribed.
I cannot tell you how many times I have gone through a medication list with a patient and they turn into Jim Carey from ‘Yes Man’. Patients have a tendency to say “yes” to everything when going through a medication list, even if they are no longer taking the medication or taking it differently than prescribed.
One tactic that I use in my practice is asking the patient to finish my sentences. For example, I might say “your medication list says that you are taking apixaban, but can I confirm the dose with you? … and how many times per day were you taking that?”. By doing this, you are able to guide the pace of the conversation so that you can complete the medication review usually in under 5 minutes.
Another tactic that I sometimes use is getting patients to list their medications verbally and playing the opposite role in filling in any gaps. I don’t like this as much though, as it still plays into confirmation biasses, and usually takes longer as you are letting the patient guide the pace of the conversation.
Using tactics like these help to avoid confirmation bias, and engages the patient in an open conversation about their medications. By executing this practice, you ensure that you have accurate information, allowing you to provide the highest standard of care possible.
Documenting Medication History
Finally, it is important to document the patient’s medication history in their dental record. This information should be updated regularly on each appointment visit as per the guidelines by the BC College of Dental Health Professionals. I know that this process can take some time, but by having a complete medication history, you can provide better care to your patients and avoid potential drug interactions.
By using the DentalRx app, you can quickly and efficiently record and review patient medical histories. This is made possible by our Patient Med History module, which allows for you to enter patient medication using our drug database of over 1000 medications and analyze them in a comprehensive patient report.
