Accuracy of best possible medication history documentation by pharmacists at an Australian tertiary referral metropolitan hospital

Abstract

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.

Accuracy of best possible medication histories by pharmacy students: an observational study

“…Our study identified that high-risk medication deviations were significantly associated with ‘blood and blood forming organs’ medications, which is consistent with literature [ 33 , 34 ]. Similarly, to other studies, the most common discrepancy type was drug omission [ 4 , 14 , 15 , 17 , 20 , 34 , 35 ].…”

Pharmacy student-assisted medication reconciliation: Number and types of medication discrepancies identified by pharmacy students

“…Our results are similar to another Australian study that showed there was no difference in number of discrepancies identified when conducting medication reconciliation between medical and surgical units. 21 In particular, our study showed that geriatrics and cardiothoracic surgery had a higher proportion of patients with medication discrepancies than other specialties and may benefit the most from having pharmacy students conduct medication histories.…”

Sources of medication omissions among hospitalized older adults with polypharmacy

“…To date, with the exception of a few, 10,11 most studies that apply BPMH methodology have been conducted in non‐U.S. healthcare settings 12–17 . Although quality improvement interventions, such as MARQUIS, have demonstrated the value of taking a BPMH, 11 there is limited research data on the added medication information derived from multiple information sources to generate a BPMH under ideal conditions, or patient factors that may be associated with medication discrepancies at hospital admission.…”

“…To date, with the exception of a few, 10,11 most studies that apply BPMH methodology have been conducted in non-U.S. healthcare settings. [12][13][14][15][16][17] Although quality improvement interventions, such as MARQUIS, have demonstrated the value of taking a BPMH, 11 there is limited research data on the added medication information derived from multiple information sources to generate a BPMH under ideal conditions, or patient factors that may be associated with medication discrepancies at hospital admission. Considering this gap, the objectives of this study were to: (1) describe a multipronged approach to collect a comprehensive admission medication list for hospitalized older adults using four information sources-EMR, pharmacy refill history, patient/ family self-report, and outside medical records, when applicable; (2) compare these medication information sources and quantify medication discrepancies; and (3) identify patient factors associated with the number of medication discrepancies at hospital admission.…”