You will hopefully have listed prescription only medications (POMs) and pharmacy medications (P) and over the counter (OTC) medications. More difficult here is the medications that patients do not always think of as ‘drug medications’. Some patients think for example that herbal remedies are not important but in fact they have active ingredients that can interact with prescribed treatments or can be the cause of the patient’s presenting problem. (See Drug Interactions).

Also treatments that have an alternative route other than by mouth such a suppository or an inhaler, can be perceived by the patient as not a drug medication. Therefore it is necessary to ask about specific ‘remedies’ or treatment that the patient may have been prescribed but do not understand as medication and also those which they may be using to ‘self-medicate’

The table below details the mnemonic PAKASPO CHIPES we have created to help you take a thorough medication history. You may feel that mnemonics should be simple words that you can remember. However, we have used this one for the past 10 years with non-medical prescribers and have found it very successful. Taking time to learn it will reap rewards. Some mnemonics are basically too simple and become confused as to what they represent; this one won’t.

This mnemonic does not take account of recreational drugs, smoking or alcohol. Using it will assist you in collecting and harvesting everything you need to ensure safety when moving on to deliberate and share with the patient your likely diagnosis and management. Look at the headings and think about how you might frame your enquiry about the patients’ POMs and what you need to know about other than the names of the drugs. Now think about how you will ask about a patient’s adherence to, and their knowledge of, the POMs they are taking.

A Mnemonic for efficient and effective medication history taking

The PAKASPO CHIPES framework involves some straight forward self-explanatory questioning “do you use any creams, lotions or gels” whilst other areas require further expansion. It is not sufficient to only discover the name of the drugs the patient is taking but also the dosage and frequency in order to identify possible under dosage or over dosage and other non-therapeutic regimes. Care also needs to be taken to avoid premature closure of medication questioning after the patient has listed two or three medications. This may occur when patients’ are taking several medications, they can lose track of what they have told you so far and stop. If you do not check and ask “anything else?”, “is that all your prescribed medicines?” you risk missing important drug information. If a patient is discharged from hospital having been started on a new drug or receives a prescription for a new drug at the surgery and has not had the treatment rationale explained, then it is understandable that the patient is less likely to take the recommended treatment. If a patient does not know the purpose of their medication it is fairly hard to disguise and treading carefully in order not to embarrass is paramount.

Why might patients not take prescribed medication?

What do you understand about the term compliance?