Accuracy of patient self-administered medication history forms in the emergency department.

OBJECTIVES: The primary objective of this study was to determine the proportion of patients with medication discrepancies when using a self-administered medication history form in the emergency department (ED). The secondary objectives were to identify predictors of medication discrepancies and determine the proportion of patients with a high-risk medication discrepancy. METHODS: This was a cross-sectional study conducted in an urban ED in Australia. Patients completed a self-administered medication history form while waiting to be seen by a physician. Subsequently, a best possible medication history was taken by a pharmacist to determine accuracy of the self-reported medication lists for patients with planned admissions. Discrepancies between the two medication lists were reported descriptively. A Poisson regression analysis was conducted to identify predictors of the rate of discrepancies. Associations were reported as incident rate ratios (IRR). RESULTS: A total of 138 patients were included in the study. The total number of discrepancies was as follows: 0 (25%, n = 34), 1 (34%, n = 47), 2 (11%, n = 15), and ≥3 (30%, n = 42). The number of medications (IRR 1.11, 95% CI 1.09 to 1.14, p < 0.001), female (IRR 1.51, 95% CI 1.18 to 1.92, p = 0.001), and missing community pharmacy information (IRR 2.10, 95% CI 1.64 to 2.68, p < 0.001) were significantly associated with rate of discrepancies. Overall, 20% (n = 28) of patients had one or more high-risk medication discrepancies. CONCLUSION: Patient self-administered medication history forms have a high rate of discrepancies and should be verified by a best possible medication history.

Proposal for a new study design and endpoint in research on medication history taking.

Introduction: Medication history errors at hospital admission are common and effective strategies to improve the quality of medication histories are still being researched. However, studies on new approaches regarding medication history taking are often time-consuming and resource-intensive. The gold standard when evaluating the quality of medication histories is the comparison of a Best Possible Medication History to the original. However, this double collection requires significant resources, disrupts clinical procedures, and places an additional burden on patients. Therefore, more efficient study designs need to be explored. We aimed to develop a design for future studies on medication history taking that uses fewer research resources and places less strain on patients and staff. Discussion: We first identified shortcomings of the established study designs on medication history taking and subsequently defined requirements for a new design. A pragmatic study with an alternative endpoint was identified in a previous literature search. It served as the starting point from which we developed a new study design to assess the quality of approaches to medication history taking. Instead of taking a second medication history, a patient's pre-existing medication document can be used as comparator to determine the quality of the medication history. Furthermore, we defined a new primary endpoint, i.e. the number of updates per patient. Updates are differences between the newly acquired medication history and the comparator. They include discontinued, initiated, and changed medications. To enhance our proposed design, we recommend a preparatory phase to identify a suitable comparator document, and a baseline phase to assess the current process. Conclusion: We propose a more resource-efficient study design with a new endpoint. We plan to test its feasibility and evaluate whether it could enhance the efficacy of research on medication history taking in a pilot project.

Evaluating a medication history-taking entrustable professional activity and its assessment tool - Survey of a statewide public hospital pharmacy service.

INTRODUCTION: Entrustable Professional Activities (EPAs) are tasks that professionals within a field perform autonomously. EPAs are incorporated in workplace-based assessment tools to assist training and professional development. Few studies have evaluated medication history-taking EPAs use in pharmacy practice and none have sought stakeholder feedback on their use. This study evaluates the quality of the medication history-taking EPA utilized in South Australian public hospitals and the usability of its assessment tool. METHODS: A voluntary online questionnaire was conducted from July 15th to September 2nd 2021 to gather the opinions of stakeholders on the use of the medication history-taking EPA. The questionnaire was developed based on tools identified in the literature and utilized 14 open-text and five-point Likert scale questions. The questionnaire was distributed using Survey Monkey® to a purposive sample of staff and students. RESULTS: 82 responses were received from 218 surveys distributed, yielding a response rate of 38%. Respondents believed the EPA promotes learner development (90.6%) and the provision of useful feedback (83%). 94.3% considered the EPA to be easy to use but only 56.6% indicated that using it fits easily within their workday. Time constraints and the presence of context-specific descriptors were commonly perceived as limitations. Some stakeholders indicated a lack of understanding of entrustment decisions. CONCLUSION: The EPA and its assessment tool were perceived to have good quality and usability. Reducing the length of the tool, broadening its applicability across contexts, and improving user understanding of entrustment decision-making may support better use of the tool.

Patient completion of self-administered medication history forms in the emergency department.

BACKGROUND: A self-administered patient medication history form may improve efficiency of workflow in the emergency department. The objective of this study was to evaluate the patient perspective of completing a self-administered medication history form in the emergency department. METHODS: This was a cross-sectional survey of patients who presented to an urban emergency department in Australia. Face and content validity of the survey was established via an iterative process that included pharmacists and patients. After completing a self-administered medication history form, patients were surveyed regard their perspective of this approach. The results of each survey question were evaluated descriptively. RESULTS: A total of 113 completed the survey. The mean age was 59±19 years, and 52% were male. Most patients (87%, n=98) did not think there were any problems completing a self-administered list while waiting to be seen by a physician or pharmacist in the emergency department. Some patients preferred other modalities for clinicians to obtain the list due to their lack of recollection or confusion (4%, n=4), preferred that clinicians utilised existing lists or evaluated medications brought with them (2%, n=2), preferred the convenience of answering questions rather than writing (1%, n=1), or did not list a reason (1%, n=1). CONCLUSION: Most patients who present to the emergency department view a self-administered medication history form positively.

Custom and practice: a multi-center study of medicines reconciliation following admission in four acute hospitals in the UK.

BACKGROUND: Many studies have highlighted the problems associated with different aspects of medicines reconciliation (MR). These have been followed by numerous recommendations of good practice shown in published studies to decrease error; however, there is little to suggest that practice has significantly changed. The study reported here was conducted to review local medicines reconciliation practice and compare it to data within previously published evidence. OBJECTIVES: To determine current medicines reconciliation practice in four acute hospitals (A-D) in one region of the United Kingdom and compare it to published best practices. METHOD: Quantitative data on key indicators were collected prospectively from medical wards in the four hospitals using a proforma compiled from existing literature and previous, validated audits. Data were collected on: i) time between admission and MR being undertaken; ii) time to conduct MR; iii) number and type of sources used to ascertain current medication; and iv) number, type and potential severity of unintended discrepancies. The potential severity of the discrepancies was retrospectively dually rated in 10% of the sample using a professional panel. RESULTS: Of the 250 charts reviewed (54 Hospital A, 61 Hospital B, 69 Hospital C, 66 Hospital D), 37.6% (92/245) of patients experienced at least one discrepancy on their drug chart, with the majority of these being omissions (237/413, 57.1%). A total of 413 discrepancies were discovered, an overall mean of 1.69 (413/245) discrepancies per patient. The number of sources used to reconcile medicines varied with 36.8% (91/247) only using one source of information and the patient being used as a source in less than half of all medicines reconciliations (45.7%, 113/247). In three out of the four hospitals the discrepancies were most frequently categorized as potentially requiring increased monitoring or intervention. CONCLUSION: This study shows higher rates of unintended discrepancies per patient than those in previous studies, with omission being the most frequently occurring type of discrepancy. None of the four centers adhered to current UK guidance on medicines reconciliation. All four centers demonstrated a strong reliance on General Practitioner (GP)-based sources. A minority of discrepancies had the potential to cause injury to patients and to increase utilization of health care resources. There is a need to review current practice and procedures at transitions in care to improve the accuracy of medication history-taking at admission by doctors and to encourage pharmacy staff to use an increased number of sources to validate the medication history. Although early research indicates that safety can be improved through patient involvement, this study found that patients were not involved in the majority of reconciliation encounters.