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 (AU)

Las guías del Comité Consultivo Farmacéutico Australiano piden que se realice un historial de medicación detallado en el punto de ingreso del hospital. Para optimizar los resultados en salud son vitales los historiales de medicación fiables que han demostrado reducir las tasas de mortalidad. Este estudio trató de examinar la fiabilidad de los historiales de medicación tomados en el Servicio de Urgencias del Hospital Real de Adelaida registradas por el personal médicos y se compararon con las extraídas por un investigador de farmacia. El estudio, conducido durante seis semanas, incluyó 100 pacientes de mas de 70 años que tomaban cinco o mas medicamentos habituales, tenían tres o más comorbilidades y/o habían sido dados de alta del hospital en los tres meses anteriores al estudio. Después de las entrevistas a los pacientes, el investigador contactaba al farmacéutico y al médico del paciente para la confirmación y compleción del historial. Del as 1152 medicaciones registradas como utilizadas por los 100 pacientes, se encontraron discrepancias en 966 (83,9%). Hubo 563 (48,9%) omisiones completas de medicación. Las discrepancias más comunes fueron la omisión de dosis y frecuencia. Las discrepancias eran mayoritariamente medicaciones dermatológicas y para problemas de oído, nariz y garganta, pero alrededor del 29% eran usadas para tratar problemas cardiovasculares. Este estudio da apoyo a la presencia de un farmacéutico en un Servicio de Urgencias que pueda compilar un historial de medicación intensivo y fiable para mejorar la gestión del a medicación en el continuum de la atención. Es recomendable contactar con el farmacéutico comunitario y el médico del paciente para la clarificación y confirmación del historial de medicación (AU)

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.