Medication History Taking in Emergency Department Triage Is Inaccurate and Incomplete

Abstract

Objectives: Medication error prevention has become a priority in health care. The Joint Commission recommends that a list of medications, dosages, and allergies be obtained from all patients. The authors sought to determine the accuracy of medication history taking in emergency department (ED) triage. The hypothesis was that there would be significant discrepancies between medications listed in triage and those the patient was actually taking. Methods: This was a prospective, cross-sectional survey of adult patients presenting to the ED. As a part of regular care, nurses recorded a medication list during triage in the electronic medical record (EMR). For this study, the triage medication list was rechecked during an independent patient interview. Results: Of 1,797 patients approached, 1,657 completed the survey (92%). The mean age was 39 years (standard deviation [SD] ±16 years). Discrepancies in medication lists obtained during triage were documented in 626 (37%) patients. Discontinued medications (163, 9.8%) were included, additional medications (463, 27.9%) were omitted, and 632 patients (38%) reported taking a nonprescription medication not listed in the EMR. Conclusions: Medication histories performed in ED triage are inaccurate and incomplete. ACADEMIC EMERGENCY MEDICINE 2011; 18:102-104 ª 2011 by the Society for Academic Emergency Medicine M edication errors are a major cause of morbidity and mortality. It is estimated that 9.7% of patients involved in an adverse drug event (ADE) have a resulting disability. 1 Patients who experience an ADE have twice the risk of death as those who do not. 2 The Institute of Medicine (IOM) estimates 1.5 million preventable ADEs occur annually, costing $3.5 billion per year. 3 ADEs translate into increased emergency department (ED) utilization. Approximately 177,000 ED visits by elders are attributed to drug misadventures annually. 4 These numbers are considered an underestimate, as many ADEs go unrecognized or unre-ported. The IOM report and the Joint Commission have made medication safety a priority in health care. Medication errors and adverse effects can occur any time in the patient encounter, 5 and the majority of ADEs can be prevented. 6 The Joint Commission recommends a list of medications, route, frequency, dosage, allergies, and adverse reactions be recorded, a process called medication reconciliation. It is hypothesized that accurate reconciliation prevents therapeutic duplications, drug omissions, drug-drug and drug-disease interactions , dosing errors, allergic reactions, and adverse effects. Medication lists are often inaccurate, and the limited available data suggest that medication reconciliation is often not complete in the ED. 7 This study attempts to evaluate the accuracy of medication histories performed during ED triage. We hypothesized that there would be significant discrepancies between medication lists obtained at triage and those medications patients were actually taking. We sought to determine the frequency of omitted medications , discontinued m...

Effect of Medication Reconciliation on Unintentional Medication Discrepancies in Acute Hospital Admissions of Elderly Adults: A Multicenter Study

“…Previous studies have shown that one or more medication discrepancies occur in EDs in 37–87% of individuals . The current study found a proportion (62%) in the preintervention measurement phase that lies within this range.…”

“…Because many people are hospitalized acutely through the emergency department (ED), medication history taking starts there and should be performed adequately, yet several studies show that medication history lists obtained in EDs are not accurate. One or more discrepancies occurred in 37–87% of participants …”

“…One or more discrepancies occurred in 37-87% of participants. [4][5][6] When examining strategies to improve medication history taking, electronic medication reconciliation 7 and medication reconciliation (generally defined as the process of obtaining and maintaining a complete and accurate list of the current medication use of an individual across the healthcare settings 8 ) performed by pharmacists instead of physicians 9 are effective. Pharmacy-based medication reconciliation has been shown to be one of four cost-effective strategies (out of a total of 21) to improve patient safety.…”

Altered Mental Status in Older Patients in the Emergency Department

“…Medication histories obtained from triage or from electronic medical record are notoriously inaccurate and should be confirmed with the caregiver or their pharmacy. 137,138 A history of any recent changes or additions to the patient’s home medication regimen should be elicited as well as increased dosages; the clinician should determine if these changes are temporally related to the development of symptoms. In addition to prescribed medications, history of taking over the counter medications and alternative medications should also be obtained.…”

Stress among nurses working in emergency, anesthesiology and intensive care units depends on qualification: a Job Demand-Control survey

“…Emergency nurses are exposed to a complex interplay between stress [life-and-death emergencies (Adriaenssens et al 2012), which is the defining characteristic of their job], sleep deprivation and fatigue due to repeated changes in shifts (Shao et al 2010). Work-related exhaustion can lead to various physical and psychological symptoms (Shao et al 2010) and delayed decision-making, including making treatment or medication errors (Hillin and Hicks 2010;Mazer et al 2011). Moreover, prolonged stress exposes emergency nurses to a higher risk of multiple diseases (Cohen et al 2007;Shao et al 2010), predominantly systemic inflammation (Black 2002;Elenkov et al 2005), metabolic disorders (Pervanidou and Chrousos 2012) and coronary heart disease (Cohen et al 2007;Proietti et al 2011).…”