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Who collects patients’ medication histories at your emergency department?
If the answer is physicians or nurses, you might want to rethink that.
At Cedars-Sinai Medical Center, pharmacy staff members gather the information, which, according to an article published in BMJ Quality & Safety, reduces mistakes in drug orders by more than 80%.
“Across healthcare settings, errors that are introduced into the record by individuals with varying levels of knowledge can become ‘hardwired’ and used for prescribing medications that can cause harm,” explained study co-investigator Rita Shane, PharmD, chief pharmacy office at Cedars-Sinai.
To determine the benefit of pharmacy involvement in medication histories, researchers performed a three-arm randomized controlled trial of about 300 inpatients. In the two intervention arms, pharmacy staff – pharmacists in one case and pharmacy technicians in the other – obtained initial medication histories prior to admission, reconciling medication information from multiple sources. Other than that, all arms, including the control, received usual admission medication history (AMH) care.
Severity-weighted mean AMH error score, with each error assigned 1, 4, or 9 points to calculate severity-weighted AMH and admission medication order (AMO) error scores for each patient, was the primary outcome. Study authors report that mean±standard deviation (SD) AMH errors per patient in the usual care, pharmacist, and technician arms were 8.0±5.6, 1.4±1.9, and 1.5±2.1, respectively.
At the same time, mean±SD severity-weighted AMH error scores were 23.0±16.1, 4.1±6.8, and 4.1±7.0 per patient, respectively, for the usual care, pharmacist, and technician arms. The AMH errors led to a mean±SD of 3.2±2.9, 0.6±1.1, and 0.6±1.1 AMO errors per patient and mean severity-weighted AMO error scores of 6.9±7.2, 1.5±2.9, and 1.2±2.5 per patient, respectively, in the three groups.
“Pharmacists and technicians reduced AMH errors and resultant AMO errors by over 80%,” the researchers point out. “Future research should examine other sites and patient-centered outcomes.”
ED clinicians are so busy performing other tasks that medication histories often receive less attention than they should, study authors note.
“The standard practice in the U.S. is for doctors and nurses to take these histories, along with simultaneously delivering and coordinating care for the patients,” added Joshua Pevnick, MD, an assistant professor of medicine at Cedars-Sinai. “That's why it's so helpful to assign this task to pharmacy experts, whose sole role is to take these histories.”
EMTALA & the On-Call Physician
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