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

Abstract

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.

Development and Delphi validation of a Best Possible Medication History form

“…According to WHO, a BPMH should be documented in a purpose designed form to improve accuracy and efficiency of the required information, and a standardised form must be developed by the organisation conducting the BPMH 4. There is scarce literature about the development of BPMH standardised forms 11. Hospitals should thus collaborate to develop an accurate and standardized BPMH form.…”

Conciliation – a new element of pharmacovigilance

“…Jednak konieczny jest późniejszy wywiad z pacjentem, przeprowadzony przez farmaceutę w szpitalu, gdyż jako samodzielne źródło informacje podane przez pacjenta w formularzu nie są w pełni wiarygodne. Muszą one zostać sprawdzone i/lub uzupełnione przez personel medyczny, aby stanowić kompletne BPMH [15].…”

Une pratique de la pharmacie fondée sur des données probantes?

“…En effet, l'étude par MacDonald et collab. 12 dans le présent numéro du JCPH, qui s'intéresse au moyen le plus efficace d'obtenir un meilleur schéma thérapeutique possible pour les patients dans un service des urgences très fréquenté ne requérant pas une hospitalisation, sera un ajout bien nécessaire à la littérature sur le sujet. Lorsque nous aborderons notre pratique et l'adoption de normes avec la même rigueur que nous apportons aux SFDP, alors seulement pourrons-nous réellement affirmer que nous exerçons en nous appuyant sur une approche fondée sur des données probantes!…”