Emergency Department Medication History Taking: Current Inefficiency and Potential for a Self-Administered Form

Witting, Michael D.; Hayes, Bryan D.; Schenkel, Stephen M.; Drucker, Charles B.; DeWane, Michael P.; Lantry, James; Vashi, Satyam V.

doi:10.1016/j.jemermed.2013.01.019

Cited by 9 publications

(9 citation statements)

References 14 publications

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“…Errors of omission were the most common discrepancies; over 40% of patients with a discrepancy listed an allergic reaction or an ADR which was not documented in the EHR. Previous studies on medication history in the ED support the conclusion that this environment can be particularly challenging considering the time constraints and the lack of control over patient volume [8,9,13]. This high rate of errors of omission in the EMR has significant safety implications.…”

Section: Discussionmentioning

confidence: 99%

Medication Allergy and Adverse Drug Reaction Documentation Discrepancies in an Urban, Academic Emergency Department

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Medication Allergy and Adverse Drug Reaction Documentation Discrepancies in an Urban, Academic Emergency Department

et al. 2018

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“…10,11,14 The BPMH form and associated data collection tool (for use by pharmacy team members, as described below) were piloted at The Moncton Hospital on 3 separate occasions before formal data collection began, to ensure ease of use by both the patient and the pharmacy interviewer. Patients were invited to complete the BMPH form after registration, while waiting to be seen by a physician.…”

Section: Methodsmentioning

confidence: 99%

“…Previous studies (including published reports [10][11][12][13] and unpublished data by one of the authors [R.W.]) have shown that a high percentage of patients are capable of independently completing some form of a medication history.…”

Section: 3mentioning

confidence: 99%

Reliability of Best Possible Medication Histories Completed by Non-admitted Patients in the Emergency Department

Macdonald

Manuel

Brennan

et al. 2017

CJHP

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Background: Accreditation standards have outlined the need for staff in emergency departments to initiate the medication reconciliation process for patients who are at risk of adverse drug events. The authors hypothesized that a guided form could be used by non-admitted patients in the emergency department to assist with completion of a best possible medication history (BPMH). Objective: To determine the percentage of patients in the non-acute care area of the emergency department who could complete a guided BPMH form with no clinically significant discrepancies (defined as no major discrepancies and no more than 1 moderate discrepancy). Methods: This prospective exploratory study was conducted over 4 weeks in February and March 2016. Data were collected using the self-administered BPMH form, patient interviews, and a data collection form. After completion of the guided BPMH form, patients were randomly selected for interview by a pharmacy team member to ensure their self-completed BPMH forms were complete and accurate. Eligible patients were those with non-acute needs who had undergone triage to the waiting room. Patients who were already admitted and those with immediate triage to the acute care or trauma area of the emergency department were excluded. Results: Of the 160 patients who were interviewed, 146 (91.3%) completed the form with no more than 1 moderate discrepancy (but some number of minor discrepancies). There were no discrepancies in 31 (19.4%) of the BPMH forms, and 101 (63.1%) of the forms had only minor discrepancies. Conclusions: Most of the patients interviewed by the pharmacy team were able to complete the BPMH form with no clinically significant discrepancies. The self-administered BPMH form would be a useful tool to initiate medication reconciliation in the emergency department for this patient population, but used on its own, it would not be a reliable source of BPMH information, given the relatively low number of patients who completed the form with no discrepancies.

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“…Other sources include the collection and interpretation of basic physical measures (blood pressure, heart rate, blood sugar levels, etc. ), data from electronic medical information systems in the institute or the referring organization [13,14] , history taking interviews conducted by medical staff members [15] and updates from other physicians or institutes that have dealt with the patient. While this stage does not involve the physician's judgment regarding preferable choices or courses of action, it is the foundation for the stages to come.…”

Section: The Intelligence Stagementioning

confidence: 99%

Implementing combined decision models in healthcare settings: the Simon and Pauker- Kassirer models

Assuli

2013

JHA

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Background: Modeling medical decision-making has attracted considerable attention over the years, and has become the topic of many investigations. Researchers have attempted to model this critical and extremely complex process from several different angles to enable hospital clinicians to engage in decision-making using empirical tools.Purpose: This paper takes a famous managerial model of decision-making in a non-medical setting and integrates it with a well-known model of medical decision-making to generate a unified illustration of the process. Both models deal with decision-making. However, Simon's model is less easily applied to the unique process of medical decision making. The proposed integration may help bridge the gap between the models and approaches by creating a unified framework to deal with the challenge of medical decision making in hospital environments through empirical methods.Approach: Simon's model of automation provides the general structure of the decision-making process by dividing it into three stages: Intelligence, Design and Choice. The Pauker & Kassirer model deals with probabilistic and statistical applications of clinical processes, and introduces a threshold approach and decision trees as the main decision tools. The discussion explores the advantages and disadvantages of each model and what can be gained by combining them. Research limitations:Although these models were used to form an integrated framework, they were developed almost three decades apart. Therefore, caution is of the essence when applying them to real-life circumstances, and further research is needed to validate this integration.

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Emergency Department Medication History Taking: Current Inefficiency and Potential for a Self-Administered Form

Cited by 9 publications

References 14 publications

Medication Allergy and Adverse Drug Reaction Documentation Discrepancies in an Urban, Academic Emergency Department

Medication Allergy and Adverse Drug Reaction Documentation Discrepancies in an Urban, Academic Emergency Department

Reliability of Best Possible Medication Histories Completed by Non-admitted Patients in the Emergency Department

Implementing combined decision models in healthcare settings: the Simon and Pauker- Kassirer models

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