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Clinical Pharmacy Specialist and Clinical Practice Leader, Royal Columbian Hospital, Fraser Health Authority, 330 East Columbia Street, New Westminster, British Columbia V3L 3W7, Canada, fax 604/777-8378, Wendy.Gordon{at}fraserhealth.ca
Pharmacist, Royal Columbian Hospital, Fraser Health Authority
Pharmacotherapeutic Specialist, Emergency Medicine, Vancouver Coastal Health, Vancouver, British Columbia, Canada
Published Online, December 19, 2007. www.theannals.com, DOI 10.1345/aph.1K070
The procedures involved in a patient's admittance to the hospital can be lengthy because patients may have contact with many healthcare professionals in a short period. Patients admitted to the 8 bed Cardiac Intervention Unit (CIU) at Royal Columbian Hospital (RCH) in New Westminster, British Columbia, Canada, may be interviewed by as many as 8 healthcare professionals, including an ambulance attendant, an emergency department (ED) triage nurse, an ED physician, an ED nurse, a cardiologist, a medical resident, a CIU nurse, and a pharmacist. There is no standardized protocol for procuring a medication history at RCH; therefore, histories are recorded in different places in the health record, making access to this information difficult.
We conducted a pilot project to assess the discrepancies in medication histories. To obtain the best possible medication history, patients admitted to the CIU between May 29 and June 9, 2006, were interviewed by a pharmacist, who accessed community pharmacy records, interviewed the patient's family, and contacted the patient's physician to ensure that the medication history was accurate. The pharmacist also reviewed the patient's chart for the medication histories completed by other healthcare professionals during the admission process, prior to the pharmacist medication history. The history taken by the pharmacist was used as the gold standard against which the histories conducted by the other healthcare professionals were compared. Classifications of discrepancies were predefined.
Sixteen patient admissions were evaluated. Including the history obtained by the pharmacist, there were 84 separate medication histories completed by various healthcare professionals, with an average of 5.3 (range 1-6) histories documented in each patient's health record. The patients were taking an average of 4.4 (range 0-10) drugs prior to admission. A total of 258 discrepancies were identified. The 2 most prevalent errors were drug omission (43.3%), defined as failure to include a medication that the patient confirmed was being taken prior to admission, and dose omission (32.3%), which was defined as documentation of a drug name only, with no dose specified. Other discrepancies included: medication history not documented (8.7%); drug addition (7.2%); frequency omission (4.6%); dose change (1.9%); history obtained from another source, such as the community pharmacy record (1.5%); and frequency change (0.4%). It appeared that a discrepancy made early in the patient admission process was propagated throughout later histories. No adverse outcomes were observed as a result of a discrepancy; all potential drug-related problems were reported to the physician.
This project highlights the importance of having a healthcare professional obtain and document a detailed medication history for every admitted patient. Recommendations for the future include providing the resources for a designated professional to obtain detailed medication histories on patient admission. Designating one healthcare professional to document medication histories would eliminate the time that other professionals spend obtaining medication information. Given their extensive knowledge of drug therapy, pharmacists are uniquely qualified to assume this role.
References
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