Injuries resulting from medication use are among the most common types of inpatient injuries at U.S. hospitals, affecting hundreds of thousands of patients every year. Errors in medication histories can lead physicians to order the wrong drug, dose or frequency.
Electronic health records help, but not enough, because errors that are introduced into the record by individuals with varying levels of knowledge can become 'hardwired' and used for prescribing medications that can cause harm. Patients in the Emergency Department pose special challenges. They may be unable to offer information because they are unconscious or otherwise compromised by a health crisis. A medication list found in a person's wallet may be for a family member, or a drug on the list may have been discontinued by the patient months ago.
A recent paper detailed a three-arm randomized controlled trial of 306 inpatients who were taking 10 or more prescription drugs and had a history of heart failure or other serious conditions. In one intervention arm, pharmacists, and in the second intervention arm, pharmacy technicians, obtained initial admission medication histories prior to admission. Pharmacists and technicians reduced admission medication history errors and resultant admission medication orders errors by over 80 percent.
To ensure accuracy when taking histories, pharmacy professionals may need to reconcile electronic health records with prescription databases and any written lists from the patient, the patient’s pharmacy and the primary-care physician, along with information provided verbally by the patient or the patient's family or caregiver.
"The standard practice in the U.S. is for doctors and nurses to take these histories, along with simultaneously delivering and coordinating care for the patients," said first author Joshua Pevnick, MD, associate director of the Division of Informatics at Cedars-Sinai. "That's why it's so helpful to assign this task to pharmacy experts, whose sole role is to take these histories."
Acting on the findings, Cedars-Sinai now assigns pharmacy staff members to take medication histories for high-risk patients admitted to the hospital through the Emergency Department.
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