Journal Article

A multicentre, double-blind, randomised, controlled, parallel-group study of the effectiveness of a pharmacist-acquired medication history in an emergency department

Becerra-Camargo, Jesus, Martinez-Martinez, Fernando, Garcia-Jimenez, Emilio

2013

Overview

Background Admission to an emergency department (ED) is a key vulnerable moment when patients are at increased risk of medication discrepancies and medication histories are an effective way of ensuring that fewer errors are made. This study measured whether a pharmacist-acquired medication history in an ED focusing on a patient’s current home medication regimen, and available to be used by a doctor when consulting in the ED, would reduce the number of patients having at least 1 medication discrepancy related to home medication. Methods This multicentre, double-blind, randomised, controlled parallel-group study was conducted at 3 large teaching hospitals. Two hundred and seventy participants were randomly allocated to an intervention (n = 134) or a standard care (n = 136) arm. All consecutive patients >18 years old admitted through the ED were eligible. The intervention consisted of pharmacists conducting a standardised comprehensive medication history interview focusing on a patient’s current home medication regimen, prior to being seen by a doctor. Data recorded on the admission medication order form was available to be used by a doctor during consultation in the ED. The admission medication order form was given to doctors at a later stage in the control arm for them to amend prescriptions. The effect of the intervention was assessed primarily by comparing the number of patients having at least 1 admission medication discrepancy regarding medication being taken at home. Secondary outcomes concerned the characteristics and clinical severity of such medication discrepancies. Results The intervention reduced discrepancies occurring by 33% (p < 0.0001; 0.1055 odds ratio, 0.05-0.24 95% confidence interval), despite recall bias. Regarding total discrepancies, omitting medication occurred most frequently (55.1%) and most discrepancies (42.7%) were judged to have the potential to cause moderate discomfort or clinical deterioration. Conclusions A pharmacist-acquired medication history in an ED focusing on a patient’s current home medication regimen available to be used by a doctor at the time of consulting in the ED reduced the number of patients having at least 1 home medication-related discrepancy. Trial registration Current Controlled Trials ISRCTN63455839 .

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V
• Subject: Agreements / Double-Blind Method / Drug stores / Emergency medical care / Emergency Service, Hospital - organization & administration / Health Administration / Health care teams / Health Informatics / Hospitals / Hospitals, Teaching - methods / Hospitals, Teaching - organization & administration / Humans / Information sources / Interviews / Male / Medical History Taking - methods / Medical records / Medication Errors - prevention & control / Medication reconciliation / Medication Reconciliation - methods / Medication Reconciliation - organization & administration / Medicine / Medicine & Public Health / Methods / Middle Aged / Nursing Research / Patient Admission / Patient safety / Pharmacists / Physicians / Program Evaluation / Public Health / Quality / Research Article / safety and outcomes