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CHAPTER 1: APPLYING THE PHARMACIST PATIENT CARE PROCESS TO CARE TRANSITIONS

When collecting a best possible medication history (BPMH) for the patient, which of the following is the preferred source of information?

A. The patient

B. The patient’s daughter

C. The patient’s pharmacy records

D. The patient’s primary care physician

Correct answer: A

Rationale: At each care transition, patients will have a different set of needs that the pharmacist must address. Upon admission to the ED, this includes collection of a best possible medication history and admission medication reconciliation. The BPMH should include a comprehensive list of all medications the patient is taking, including over-the-counter medications and supplements. It should also include an assessment of adherence to inquire how the patient is actually taking their medications, and identify if, and why, the patient may be taking medications differently than prescribed. A patient interview is preferred, with verification from a second source, as the patient can provide the most comprehensive and up-to-date information as well as identify any adherence issues. In this case, the patient lives alone and seems to be managing her own health. There is no indication that the patient is an unreliable historian, such as confusion or involvement of a caregiver, although it would be important to collect this information and identify if any other caregivers or co-learners should be involved in decision-making and education. There is also no indication that her daughter is directly involved with her care. Pharmacy records and medical records from a physician are also excellent resources to verify patient medication lists but may not provide a comprehensive picture.

What is the most likely cause of the patient’s suspected peptic ulcer?

A. Helicobacter pylori infection

B. Stress

C. Weight gain

D. Nonsteroidal anti-inflammatory drugs (NSAIDs) use

Correct answer: D

Rationale: In order to comprehensively address the patient’s needs, we must assess the information we have collected to conduct an accurate assessment of the patient’s current problem. We must consider how this patient’s health information impacts interventions including medication reconciliation, therapy planning and implementation, patient education, adherence barriers, and care coordination. The patient has been taking ibuprofen twice daily for back pain since her fall 2 months ago. Additionally, she has been taking Alka Seltzer, which contains 325 mg of aspirin per tablet, to ease her “stomach upset.” Excessive NSAID use can cause a peptic ulcer and increased risk of gastrointestinal bleed, which is consistent with the patient’s clinical presentation of tarry stools ...

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