Which Medication Is the Patient Taking at Admission to the Emergency Ward? Still Unclear Despite the Swedish Prescribed Drug Register

Accuracy of medication histories derived from an Australian cloud-based repository of prescribed and dispensed medication records

BACKGROUND

Obtaining accurate medication histories at transitions of care is challenging, but important for patient safety. Prescription exchange services (PES) securely transfer electronic prescription and dispensing records between prescribers and pharmacies; potentially useful data for determining medication histories.

AIM

To evaluate the accuracy of PES-derived medication histories.

METHODS

Prospective observational study, at two Australian tertiary-referral health-services. A convenience sample of adult inpatients was recruited. The main outcome measure was: proportion of patients with ≥1 errors in their PES-derived pre-admission medication histories, compared to gold-standard best-possible medication histories, including prescribed and non-prescribed medications, obtained by pharmacists using multiple sources including patient/carer interview.

RESULTS

153/154 (99.4%) patients (median age 76years, inter-quartile range [IQR] 64-84years, median 10.0 pre-admission medications, IQR 6.0-14.0) had ≥1 errors in their PES-derived medication history (median 6.0 per patient, IQR 4.0-9.0). Excluding when-required (PRN) medications, 146 (94.8%) patients had a median of 4.0 errors (IQR 2.0-6.0). Omission was the most common error, affecting 549/1648 (33.3%) current medications (median 3.0, IQR 1.0-5.0 per patient); 396 [72.1%] omissions were over-the-counter medicines. Dose-regimen errors affected 276/1099 (25.1%) current medications captured in PES-derived medication histories (median 1.0, IQR 0.0-3.0 per patient). Commission errors (medications in PES-derived histories that weren't current) affected 224/1383 (16.2%) medications (median 1.0, IQR 1.0-2.0 per patient).

CONCLUSIONS

Medication histories derived solely from a cloud-based medication record repository had a high error rate compared to patients' actual medication use. Like all medication history sources, data from cloud-based repositories need to be verified with additional sources including patients and/or carers. This article is protected by copyright. All rights reserved.