Patient‐Completed Medication Histories versus those Obtained by a Pharmacist in a Pre‐admission Clinic

Abstract

Aim: To evaluate the accuracy and completeness of patientcompleted medication histories to those obtained by a pharmacist in a pre-admission surgical clinic. Method: This prospective study was conducted over 3-weeks with patients attending a pre-admission surgical clinic. Consecutive patients had a pre-admission assessment with the pre-admission clinic pharmacist. Comparison was made regarding the accuracy of information between patient-completed medication history and assessment by the pre-admission clinic pharmacist. Results: 150 patients were enrolled -33 (22%) had a patientcompleted questionnaire that was totally correct. There was an average of 3.9 drug discrepancies per patient-completed medication history. The discrepancies included: omitted drugs (317), incorrect doses (24), doses omitted (110), dosing frequency incorrect (24) or dosing frequency omitted (63). The adverse drug reaction status was recorded correctly on 85% of patientcompleted medication histories. Conclusion: Patient-completed medication histories used in a pre-admission surgical clinic were not accurate in 4 out of 5 patients. Pharmacists in a pre-admission clinic can ensure the availability of an accurate medication history.

Comparison of medication history interview conducted via telephone with interview conducted face‐to‐face for elective surgical patients

“…Medication errors at the hospital interface are a common occurrence . An accurate and comprehensive medication history on admission is imperative to patient safety, and is outlined in the National Safety and Quality Health Service Standards (NSQHS) .…”

“…Incomplete medication histories can lead to medication discrepancies during hospitalisation, which may be perpetuated following discharge . Reductions in medication discrepancies have been demonstrated with pharmacist involvement in an elective procedures admission clinic (EPAC) . While the role of the pharmacist within EPAC encompasses assessment of current medication management, formulating a management plan for medication cessation or substitution and provision of information about medicines management during an inpatient stay, the documentation of a best possible medication history (BPMH) is a core component of an EPAC pharmacist's work.…”

“…At present, documentation of current medications for this population is self‐reported in a pre‐procedure screening tool. The reliability of such patient‐completed medication histories was examined by Dooley et al . who found 78% of EPAC patients had an inaccuracy in their medication history, with an average of 3.9 drug discrepancies per self‐completed history.…”

Impact of a Surgical Preadmission Clinic Pharmacist on the Quality of Medication Management from Preadmission to Discharge: a Randomised Controlled Study

“…Surgical preadmission clinics (PACs) are an established service in many hospitals. [1][2][3][4][5][6][7] The main objective of PACs is to provide surgical and anaesthetic assessments of patients prior to elective surgery, in order to avoid surgery cancellations and enable patient admission on the day of surgery. Surgical PACs also provide an opportunity for patient education, allied health access, discharge planning and obtaining patient information.…”

“…The question of whether experienced clinical pharmacists can add value to PACs has stimulated research in recent years. [1][2][3][4][5][6][7]9 Surgical PAC pharmacists have been involved in medication history documentation, medication reconciliation, pre-and post-operative medication management, writing prescriptions, providing medicines information, patient education, discharge planning and general practitioner liaison. [1][2][3][4][5][6][7] However, randomised controlled studies investigating the value of pharmacy services to PACs are limited.…”