The aim of this study is to quantify prescribing errors relating to pre‐admission medication in patients admitted to hospital. It also assesses the impact of a hospital pharmacist in identifying and correcting these errors. Standard prescription monitoring by the pharmacist took place on admission in phase 1 (526 patients). This was compared with an extension of the pharmacist’s role in phase 2 (506 patients) by taking a detailed medication history, including assessment of patients’ own drugs (PODs). A significant increase (p < 0.001) in errors detected and corrected was identified. In phase 2, 45.1 per cent of prescription charts contained one or more errors. Of these errors, 74.8 per cent could not be identified from checking the drug chart alone. As this is the principal method by which many hospital pharmacists check patients’ medication charts this is an area of concern. More than 50 per cent of errors were considered likely to cause destabilisation of a chronic medical condition, or serious adverse events. It has been shown that an effective way to prevent these errors and ensure the continuity of medication between primary and secondary care is for pharmacists to take a detailed drug history on admission.

ObjectivesThe objectives of this study were to establish what happened to patients after they contacted a hospital-based medicines helpline, to describe the nature of the calls received and to measure patient satisfaction. The study also set out to investigate whether access to patients' hospital records or local expertise was necessary to answer the calls received.MethodsTo assess what happened to patients after contact with the helpline and their satisfaction with the service, consenting callers were sent a questionnaire. To capture the nature of calls received, and investigate how often access to local knowledge was required, a retrospective analysis of calls was performed.ResultsPatients and their carers followed the advice given in 95.9% (n=93) of cases. Patients rated their problem as having been resolved as the most frequent outcome (52.2% n=35), followed by feeling reassured about their medicine or illness (44.8% n=30). On a 6-point rating scale (where 1 was poor and 6 was excellent) 80.2% (n=77) of respondents rated the helpline service as 6, and a further 15.6% (n=15) as 5. Patients mainly called with concerns about safety or how to take medicines and some related to discharge errors. Access to local knowledge was required in 74.5% (n=149) of cases.ConclusionsThe helpline helps to reassure patients when they return home from hospital. They trust and follow the advice given, and have their medication-related problems resolved. Prompt access to patients' records or local expertise is an advantage for the successful running of the helpline.

Objectives To determine the impact of advice provided by Medicines Information services in National Health Service hospitals across England, Scotland and Wales, on patient care and clinical outcomes, and medicines safety. Methods All healthcare professionals seeking advice on specific patients from participating Medicines Information services were invited to complete an online questionnaire to determine the impact of that advice on their patients. A multidisciplinary expert panel of healthcare professionals independently assessed the impact of advice for a sample of enquiries using an impact rating scale. Results A total of 647 pharmacists, doctors and nurses sought advice from 62 Medicines Information services and completed questionnaires. Most (81%) needed Medicines Information advice before proceeding with their patients’ treatments, 99% used the advice in managing their patients, resulting in 92% (597/647) reporting a positive impact: a positive impact on patient care or outcome was reported for 85% of patients (547/647), a positive impact on medicines safety was reported for 77% of patients (499/647) and 15% of patients avoided a major risk (96/647). Agreement between enquirers and expert panel on impact was substantial for patient care and outcome (κ=0.62; p=0.001) and fair for medicines safety (κ=0.40; p=0.043). In 22% of cases (145/647), Medicines Information identified and advised on medicines issues that enquirers had not identified themselves which was associated with a positive impact on patients (p<0.01). Conclusions Clinical advice from Medicines Information services across the UK to healthcare professionals had high levels of positive impact on patient care, outcomes and medicines safety.

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