An evaluation of a collaborative, safety focused, nurse-pharmacist intervention for improving the accuracy of the medication history.

OBJECTIVE: To evaluate the impact of a standardized approach to collecting a medication history on the accuracy of the admission medication list. METHODS: Pharmacists and nurses developed and implemented a structured, systematic assessment tool for use by nurses in obtaining a medication history. The tool was first evaluated with nursing students in an educational setting using mock patients and simulated scenarios. The number and type of medication errors (omissions) were compared between controls and those using the tool. Based on the findings from this phase of the study, we refined the tool and then implemented it on four medical/surgical units in a large academic teaching hospital and a smaller, affiliated community hospital. We compared medication error rates using hospital safety report records and discrepancies (i.e., delays in ordering, omissions) before and after implementation of the tool. RESULTS: Accuracy of the medication history improved significantly with student nurses who used the tool versus those who did not (87% versus 74%, P = 0.010). We were unable to evaluate the numbers of medication discrepancies in the academic medical center because of a lack of availability of electronic admission history and physical reports during the study period. At the community hospital, there was a significant increase in the percentage of patients without medication discrepancies (before = 20% versus after = 42%, P = 0.017), a significant reduction of minor medication omissions during the hospital stay (1.10 versus post 0.60, P = 0.003) and a trend toward the reduction of important drug omissions in the discharge summary (pre 0.43 [0.71] versus post 0.18 [0.44], P = 0.053). The most common agents involved in a delay or omission were multivitamins, laxatives, antidepressants, antidiabetic agents, platelet inhibitors, and acid-suppressing agents. CONCLUSIONS: The use of a structured tool to systematically obtain a medication history produced a measurable improvement in the accuracy of the admission medication list by student nurses and a reduction of medication errors in a community hospital.

Update on psychotropic medication use in renal disease.

Renal failure is a common medical condition, and many patients have comorbid psychiatric disorders. In this review, which is intended as a resource for consultation psychiatrists, the authors discuss pharmacokinetic considerations and provide information about the use of individual psychotropic medications in patients with renal disease. Most psychotropic medications are fat soluble, easily pass the blood-brain barrier, are not dialyzable, are metabolized primarily by the liver, and are excreted mainly in bile. Consequently, the majority of these drugs can be safely used with the end-stage renal disease population.