Background Medication histories (MHs) obtained at the time of patients’ admission to hospital are often incomplete, and lack of information about patients’ actual medicine use can potentially lead to prescribing failures and serious adverse events. Uses of clinical pharmacists in obtaining MHs are beneficial, but due to limited economic resources clinical pharmacists cannot be present in every hospital ward, and therefore pharmacy technicians (PTs) could probably be trained in obtaining MHs. Objective To compare discrepancies in MHs obtained by physicians and PTs in an emergency department. Second to evaluate, whether PTs could assist and/or replace physicians in obtaining MHs. Methods The study was conducted in the emergency department at Svendborg Hospital, Denmark and patients treated with a minimum of three prescribed medicines were included. On patients’ admission to hospital, physicians recorded the primary MHs, and within 48 h the secondary MHs were made by PTs. All MHs were conducted using standard guidelines. A clinical pharmacist reviewed the MHs, and based on these reviews, a final medication list was defined, and the MHs were compared to this. The discrepancies were registered with respect to type and therapeutic group (medicines). Results A total of 113 patients were included in this study, and data for 106 patients were analysed. On average, three discrepancies were detected for each patient in the primary MHs, and less than one discrepancy per patient in the secondary MHs. A total of 1075 prescriptions were registered, and for the physicians, 287 discrepancies (27 % of total prescriptions) were found, and for PTs the number was 28 (2 % of total prescriptions). The commonly detected discrepancy was “drug missing in the electronic patient record”. The largest number of discrepancies was found for nervous system medications (ATC group N), medicines from ATC group A (alimentary tract and metabolism) and respiratory medicine (ATC group R). Conclusion Fewer discrepancies in the MHs obtained by PTs than physicians were detected compared to standard medicine lists made by an experienced clinical pharmacist.
Clinical pharmacy Denmark Medication history Medication list Medication review Pharmacist Pharmacy technician Physician
This is a preview of subscription content, log in to check access.
We thank pharmacist Zainab Nawar Ajina for designing the study, and the pharmacy technicians, Margrethe Mikkelsen and Ditte Juul Jakobsen for data collection.
No sources of funding were used to assist in the preparation of this study.
Conflicts of interest
The authors declare no conflicts of interest with regard to this study.
Kohn LT, Corrigan JM, Donaldson MS. To err is human: building a safer health system. Washington, DC: National Academy Press; 1999. ISBN 978-0-309-26174-6.Google Scholar
Agrawal A, Aronson JK, Britten N, Ferner RE, de Smet PA, Fialova D, et al. Medication errors: problems and recommendations from a consensus meeting. Br J Clin Pharmacol. 2009;67:592–8.PubMedCentralCrossRefPubMedGoogle Scholar
Ghazanfar MN, Honoré PH, Nielsen TR, Andersen SE, Rasmussen M. Hospital admission interviews are time-consuming with several interruptions. Dan Med J. 2012;59:A4534.PubMedGoogle Scholar
Barker KN, Flynn EA, Pepper GA. Observation method of detecting medication errors. Am J Health Syst Pharm. 2002;59:2314–6.PubMedGoogle Scholar
Lau HS, Florax C, Porsius AJ, De Boer A. The completeness of medication histories in hospital medical records of patients admitted to general internal medicine wards. Br J Clin Pharmacol. 2005;49:597–603.CrossRefGoogle Scholar
Andersen SE, Pedersen AB, Bach KF. Medication history on internal medicine wards: assessment of extra information collected from second drug interviews and GP lists. Pharmacoepidemiol Drug Saf. 2003;12:491–8.CrossRefPubMedGoogle Scholar
Tam VC, Knowles SR, Cornish PL, Fine N, Marchesano R, Etchells EE, et al. Frequency, type and clinical importance of medication history errors at admission to hospital: a systematic review. CMAJ. 2005;173:510–5.PubMedCentralCrossRefPubMedGoogle Scholar
Cornish PL, Knowles SR, Marchesano R, Tam V, Shadowitz S, Juurlink DN, et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005;165:424–9.CrossRefPubMedGoogle Scholar
Lau HS, Florax C, Porsius AJ, De Boer A. The completeness of medication histories in hospital medical records of patients admitted to general internal medicine wards. Br J Clin Pharmacol. 2000;49:597–603.PubMedCentralCrossRefPubMedGoogle Scholar
Beers MH, Munekata M, Storrie M. The accuracy of medication histories in the hospital medical records of elderly persons. J Am Geriatr Soc. 1990;38:1183–7.CrossRefPubMedGoogle Scholar
De Winter S, Spriet I, Indevuyst C, Vanbrabant P, Desruelles D, Sabbe M, et al. Pharmacist- versus physician-acquired medication history: a prospective study at the emergency department. Qual Saf Health Care. 2010;19:371–5.PubMedGoogle Scholar
Kwan Y, Fernandes OA, Nagge JJ, Wong GG, Huh JH, Hurn DA, et al. Pharmacist medication assessments in a surgical preadmission clinic. Arch Intern Med. 2007;167:1034–40.CrossRefPubMedGoogle Scholar
Becerra-Camargo J, Martinez-Martinez F, Garcia-Jimenez E. A multicentre, double-blind, randomised, controlled, parallel-group study of the effectiveness of a pharmacist-acquired medication history in an emergency department. BMC Health Serv Res. 2013;13:337.PubMedCentralCrossRefPubMedGoogle Scholar
Steurbaut S, Leemans L, Leysen T, De Baere E, Cornu P, Mets T, et al. Medication history reconciliation by clinical pharmacists in elderly inpatients admitted from home or a nursing home. Ann Pharmacother. 2010;44:1596–603.CrossRefPubMedGoogle Scholar
Reeder TA, Mutnick A. Pharmacist- versus physician-obtained medication histories. Am J Health Syst Pharm. 2008;65:857–60.CrossRefPubMedGoogle Scholar
Carter MK, Allin DM, Scott LA, Grauer D. Pharmacist-acquired medication histories in a university hospital emergency department. Am J Health Syst Pharm. 2006;63:2500–3.CrossRefPubMedGoogle Scholar
Knight H, Edgerton L, Foster R. Pharmacy technicians obtaining medication histories within the emergency department. Am J Health Syst Pharm. 2010;67:512–3.CrossRefPubMedGoogle Scholar
Tizard J. Taking drug histories—an audit of technician accuracy. Hosp Pharm. 2007;14:351–2.Google Scholar
Hart C, Price C, Granziose G, Grey J. A program using pharmacy technicians to collect medication histories in the emergency department. Pharm Ther. 2015;40:56–61.Google Scholar
Johnston R, Saulnier L, Gould O. Best possible medication history in the emergency department: comparing pharmacy technicians and pharmacists. Can J Hosp Pharm. 2010;63:359–65.PubMedCentralPubMedGoogle Scholar
Buck TC, Gronkjaer LS, Duckert M-L, Rosholm J-U, Aagaard L. Medication reconciliation and prescribing reviews by pharmacy technicians in a geriatric ward. J Res Pharm Pract. 2013;2:145–50.PubMedCentralCrossRefPubMedGoogle Scholar
De Winter SD, Spriet I, Indeveuyst C, Vanbrabant P, Desruelles D, Sabbe M, et al. Pharmacist versus physician acquired medication history: a prospective study at the emergency department. Qual Saf Health Care. 2010;19:371–5.PubMedGoogle Scholar
Michels RD, Meisel SB. Program using pharmacy technicians to obtain medication histories. Am J Health Syst Pharm. 2003;60:1982–6.PubMedGoogle Scholar
Lung M, Jung J, Lau W, Kiaii M, Jung B. Best possible medication history for hemodialysis patients obtained by a pharmacy technician. CJHP. 2009;62:386–91.Google Scholar
Remtulla S, Brown G, Frighetto L. Best possible medication history by a pharmacy technician at a tertiary care hospital. CJHP. 2009;62:402–5.CrossRefGoogle Scholar
Richardson K, Kenny RA, Peklar J, Bennett K. Agreement between patient interview data on prescription medication use and pharmacy records in those aged older than 50 years varied by therapeutic group and reporting of indicated health conditions. J Clin Epidemiol. 2013;66:1308–16.CrossRefPubMedGoogle Scholar
Nielsen MW, Søndergaard B, Kjøller M, Hansen EH. Agreement between self-reported data on medicine use and prescription records vary according to method of analysis and therapeutic group. J Clin Epidemiol. 2008;61:919–24.CrossRefPubMedGoogle Scholar