Aim: To evaluate whether medication history-taking via telephone interview is an alternative to face-to-face medication history-taking in elective surgical patients planned for admission after surgery. Method: Patients undergoing elective surgery who were planned for post-procedure admission during an 8-week period between February and March 2015 were eligible for enrolment. A semi-structured, scripted medication history interview was performed via telephone on the working day prior to the booked admission date for patients who met the inclusion criteria. Blinded comparator face-to-face histories were documented post-operatively as per standard practice. Discrepancies identified were risk stratified via consensus by a panel of three pharmacists. Results: Sixty-four patients received a telephone history interview and comparator face-to-face interview. The average number of medications was 4.47 for phone history versus 4.64 for face-to-face interview (p = 0.247). The average time to conduct a phone history interview was 5.8 min (standard deviation 3.89 min) compared to 6.69 min (standard deviation 5.01 min) (p = 0.176) for interviews conducted face-to-face. Omission or documented error of a regular prescription medication occurred with four patients (6.25%). Two errors were deemed clinically significant with the potential to cause moderate discomfort or clinical deterioration. Conclusion: Medication history interviews via telephone are a suitable alternative to face-to-face medication history-taking in lowrisk elective surgical patients who are unable or not required to attend an elective procedures admission clinic.

Iron staining is an unwanted and in some cases permanent adverse effect of intravenous iron administration. Cosmetically unacceptable staining may cause distress and have psychological implications for the patient. There should be a suitable indication for parenteral iron therapy. Patients must be advised of the risk of harm and give their informed consent before receiving parenteral iron. Strategies to minimise the risks of staining with intravenous iron include appropriate cannulation and close monitoring of the infusion. Stop the infusion if there are signs of extravasation. Laser therapy may be a treatment option in cases of persistent discolouration due to iron staining. is limited in practice, 3 but the injection can be given into an unexposed site. However, administration at an unexposed site is not necessarily possible when giving iron intravenously. A rise in reports of iron staining 6-10 may correspond with the increasing use of intravenous iron in clinical practice. 6-13 Minimising harm Specific definitive risk factors for extravasation of intravenous iron have not been published. The principles for minimising the harm associated with intravenous iron preparations have been adapted from those applied to intramuscular iron (Box 1). 5 They include a good infusion technique (Box 2). REFERENCES SELF-TEST QUESTIONS True or false? 1. Extravasation of intravenous iron leads to skin necrosis 2. The skin staining from intravenous iron usually resolves in one week

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AimTo determine the quality of best possible medication history (BPMH) taking activities undertaken by pharmacists. To identify factors which impact upon erroneous documentation. To assess risks associated with erroneous documentation of BPMH by pharmacists.MethodA clinical pharmacist randomly selected patients across a tertiary referral, metropolitan hospital over an 9-day period and documented comparator medication histories (CMHs) using a structured interview. BPMH documented by pharmacists as part of routine care and CMH were compared, and erroneous documentation was classified according to previous definitions in the literature. Erroneous documentation was risk stratified.Results99 BPMH and CMH were compared. There were 14 medication omissions which occurred across 10 patients and 14 discrepancies across 12 patients. There was no association identified between erroneous documentation and pharmacist seniority/experience (p=0.25), where BPMH taken (p=0.7), day of week BPMH documented (p=0.45) or time since admission to when BPMH was documented (p=1). Patient age did not impact erroneous documentation rates (p=0.22). There was an association between the number of sources used to confirm a medication history and erroneous documentation incidence (p=0.035). The number of medications increased the rate of documentation error. While 85.19% (n=115) of erroneous documentation were deemed unlikely to cause patient discomfort or clinical deterioration, 1.48% (n=2) had the potential to result in severe discomfort or clinical deterioration.ConclusionSix out of seven BPMH documented by pharmacists as part of usual clinical practice are accurate. Major influences on accuracy include the number of medications and sources used. There is a low possibility that erroneous documentation by pharmacists will cause harm.

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