Eliciting comprehensive medication histories in the emergency department: the role of the pharmacist
The Australian Pharmaceutical Advisory Committee guidelines call for a detailed medication history to be taken at the first point of admission to hospital. Accurate medication histories are vital in optimising health outcomes and have been shown to reduce mortality rates.
This study aimed to examine the accuracy of medication histories taken in the Emergency Department of the Royal Adelaide Hospital. Medication histories recorded by medical staff were compared to those elicited by a pharmacy researcher.
The study, conducted over a six-week period, included 100 patients over the age of 70, who took five or more regular medications, had three or more clinical co-morbidities and/or had been discharged from hospital in three months prior to the study. Following patient interviews, the researcher contacted the patient’s pharmacist and GP for confirmation and completion of the medication history.
Out of the 1152 medications recorded as being used by the 100 patients, discrepancies were found for 966 medications (83.9%). There were 563 (48.9%) complete omissions of medications. The most common discrepancies were incomplete or omitted dosage and frequency information. Discrepancies were mostly medications that treated dermatological and ear, nose and throat disorders but approximately 29% were used to treat cardiovascular disorders.
This study provides support for the presence of an Emergency Department pharmacist who can compile a comprehensive and accurate medication history to enhance medication management along the continuum of care. It is recommended that the patient’s community pharmacy and GP be contacted for clarification and confirmation of the medication history.
2. Taylor D McD, Bennett DM, Cameron PA. A paradigm shift in the nature of care provision in emergency departments. Emerg Med J. 2004;21:681-4.
3. McCrudden EA, Paloumis S, Tao MM, Burke RA, Pulver L, Meyer E, et al. Review of Pharmacist-Conducted Medication Histories at Three Teaching Hospitals. Australian Journal of Hospital Pharmacy. 1995;25:261-3.
4. Cavin A, Sen B. Improving medication history recording and the identification of drug related problems in and A&E department. Hospital Pharmacist. 2005;12:109-12.
5. Collins DJ, Nickless GD, Green CF. Medication histories: does anyone know what a patient should be taking? International Journal of Pharmacy Practice. 2004;12:173-8.
6. Gurwich E. Comparison of medication histories acquired by pharmacists and physicians. Am J Hosp Pharm. 1983;40:1541-2.
7. Nester TM, Hale LS. Effectiveness of a pharmacist-acquired medication history in promoting patient safety. Am J Health Sys Pharm. 2002;59:2221-5.
8. Slee A, Farrar K, Hughes D, Constable. Optimising medical treatment - how pharmacist-acquired medication histories have a positive impact on patient care. Pharmaceutical Journal. 2006;277:737-9.
9. Roughead EE, Gilbert AL, Primrose JG, Sansom L N. Drug-related hospital admissions: a review of Australian studies published 1988-1996. Med J Aust. 1998;168:405-8.
10. Australian Pharmaceutical Advisory Council. National guidelines to achieve the continuum of quality use of medicines between hospital and community. Canberra: Commonwealth Department of Health and Family Services; 1998.
11. Mant A, Rotem WC, Kehoe L, Kaye KI. Compliance with guidelines for continuity of care in therapeutics from hospital to community. Med J Aust. 2001;174:277-80.
12. Australian Pharmaceutical Advisory Council. Guiding Principles to achieve continuity in medication management. Canberra: Commonwealth of Australia; 2005.
13. Dutton K, Hedger N, Wills S, Brown D, Davies P. Prevent medication errors on admission. Clinical Governance: An International Journal. 2003;8(2):128-37.
14. Peterson G. The hidden dangers of complementary medicine in the elderly. Australian Pharmacist. 2004;23(9):662-4.
15. Bond CA, Raehl CL, Franke T. Clinical Pharmacy Services, Pharmacy Staffing, and the Total Cost of Care in United States Hospitals. Pharmacotherapy. 2000;20(6):609-21.
16. Bond CA, Raehl CL, Franke T. Clinical Pharmacy Services and Hospital Mortality Rates. Pharmacotherapy. 1999;19(5):556-64.
17. Harding A. The role of an Emergency Department Pharmacist. Austr J Hosp Pharm 2001;27:325-7.
18. Welch S. The Evolving Area of Emergency Medicine Pharmacy. Austr J Hosp Pharm 1997;27:325-7.
19. Gilbert AL, Roughead EE, Beilby J, Mott K, Barratt JD. Collaborative medication management services: improving patient care. Med J Aust. 2002;177:189-92.
20. Chan M, Nicklason F, Vial J. Adverse drug events as a cause of hospital admission in the elderly. Intern Med J. 2001;31:199-205.
21. Rothschild J, Bates D, Leape L. Preventable medical injuries in older patients. Arch Intern Med. 2000;160:2717-28.
22. March G, Gilbert A, Roughead E, Quintrell N. Developing and evaluating a model for pharmaceutical care in Australian community pharmacies. Int J Pharm Pract 1999;7:220-9.
23. Wilkinson D, McElroy H, Beilby J, Mott K, Price K, Morey S, et al. Uptake of health assessments, care plans and case conferences by general practitioners through the Enhanced Primary Care program between November 1999 and October 2001. Aust Health Rev. 2002;25(4):1-11.
24. Cipolle RJ, Strand LM, Morley PC. Pharmaceutical Care Practice. New York: McGraw-Hill; 1998.
25. Rossi S, editor. Australian Medicines Handbook. Adelaide: Australian Medicines Handbook; 2005.
26. Stowasser DA, Collins DM, Stowasser M. A Randomised Controlled Trial of Medication Liaison Services - Patient Outcomes. J Pharm Prac Res 2002;32(2):133-40.
27. Stowasser DA, Collins DM, Stowasser M. A randomized controlled trial of medication liaison services - acceptance and use by health professionals. J Pharm Prac Res 2002;32:221-6.
28. Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta analysis of prospective studies. JAMA 1998;279(1):1200-5.
29. Drewett M. Stop regular medication errors. Pharmacy in Practice. 1998;8(5):193-6.
30. Wilson S, Ruscoe W, Chapman M, Miller R. General practitioner-hospital communications: A review of discharge summaries. J Qual Clin Pract 2001;21(4):104-8.
31. Yu DSF, Thompson DR, Lee DTF. Disease management programmes for older people with heart failure: crucial characteristics which improve post-discharge outcomes. Eur Heart J 2006;27:596-612.
32. Lau HS, Florax C, Porsius AJ, de Boer A. The completeness of medication histories in hospital medical records of patients admitted to general internal medicine wards. Br J Clin Pharmacol 2000 Jun;49(6):597-603.
33. Wyer S. Documentation of Penicillin Allergy in a Veterans' Hospital. Austr J Hosp Pharm 1997;27(4):296-301.
34. Malhoutra S, Karan RS, Pandhi P, Jain S. Drug related medical emergencies in the elderly: role of adverse drug reactions and non-compliance. Postgrad Med J 2001;77:703-7.
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