Use of a Structured Medication History to Establish Medication Use at Admission to an Old Age Psychiatric Clinic: A Prospective Observational Study

Abstract

The number of discrepancies that were found suggests that the usual procedure for taking the medication history can be improved. The SHIM procedure enables a comprehensive and accurate overview of the medication used by older patients admitted to a psychiatric hospital, and contributes to the prevention of clinically relevant adverse drug events.

Intervention protocol: OPtimising thERapy to prevent avoidable hospital Admission in the Multi-morbid elderly (OPERAM): a structured medication review with support of a computerised decision support system

“…In order to optimise patients' pharmacotherapy during their hospital stay, their medication lists have to be as accurate as possible at the point of arrival. Several studies have shown that older patients' medication lists on admission to hospital significantly differ from what they actually take at home [26][27][28][29]. These differences can be of clinical significance, causing adverse drug events (ADEs) or patient harm [30,31] and older patients are particularly at risk from these events [32].…”

The Relationship Between Medication Discrepancies and Hospitalization Risk Among Patients With Advanced CKD

“…The US Preventive Services Task Force found minimal evidence to assess potential harms of routine BP screening, citing a single investigation of adverse effects of diagnosing children with HTN by measuring school absence rates. 2 In contrast, the American Academy of Pediatrics and the American Heart Association recommend, based on Grade C evidence, measuring BP annually beginning at age 3 years in healthy children and adolescents without risk factors for HTN (e.g., family history, obesity, kidney disease, vascular anomalies, or use of medications that increase BP). 3 There is no mention of the…”

“…In clinical practice, medication discrepancies are common, occurring in 34% to 95% of patients newly admitted to hospitals. 1,2 The results of a systematic review indicated that 11% to 59% of discrepancies were clinically relevant, 3 and that 39% could potentially cause moderate to severe harm. 1 We have previously reported that medication discrepancies are particularly common in patients with advanced chronic kidney disease (CKD; estimated glomerular filtration rate 0 to 30 ml/min per 1.73 m 2 ) not yet on dialysis, with 55% of patients having at least 1 discrepancy.…”

“…1,2 The results of a systematic review indicated that 11% to 59% of discrepancies were clinically relevant, 3 and that 39% could potentially cause moderate to severe harm. 1 We have previously reported that medication discrepancies are particularly common in patients with advanced chronic kidney disease (CKD; estimated glomerular filtration rate 0 to 30 ml/min per 1.73 m 2 ) not yet on dialysis, with 55% of patients having at least 1 discrepancy. 4 It is likely that mismatches between patients' medication use and the physician's record are more of a problem in chronic diseases.…”

The Systematic Tool to Reduce Inappropriate Prescribing (STRIP): Combining implicit and explicit prescribing tools to improve appropriate prescribing

“…A list of medications dispensed by the pharmacy and the medication vials of the patient form the basis of the medication history. This information is supplemented by information collected with a structured questionnaire, such as the Structured History taking of Medication use questionnaire, which has proven valid for this purpose . Table shows which topics need to be discussed when taking the medication history.…”