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Does Taking Medication Histories Help Prevent Errors?

December 15, 2017

The rate of medication order mistakes dropped more than 80% after pharmacy staff began taking medication histories in the emergency department, according to a study published online in the journal BMJ Quality & Safety (doi: 10.1136/bmjqs-2017-006761).

“The standard practice in the United States is for doctors and nurses to take these histories, along with simultaneously delivering and coordinating care for the patients,” said study first author Joshua Pevnick, MD, associate director of the division of informatics and assistant professor of medicine at Cedars-Sinai, in a press release (December 4, 2017). “That's why it's so helpful to assign this task to pharmacy experts, whose sole role is to take these histories.”

Hundreds of thousands of US inpatients a year are injured as a result of medication use, and errors in medication histories play a major role, said researcher Rita Shane, PharmD, chief pharmacy officer at Cedars-Sinai.

The study focused on 306 patients taking 10 or more prescription medications and with a history of heart failure or other serious conditions seeking care at, and admitted through, the emergency department Cedars-Sinai.

When pharmacists or pharmacy technicians took medication histories in the emergency department rather than the medical staff, errors in both the histories and drug orders dropped by more than 80%, researchers found. Consequently, significantly fewer medication-order errors occurred during hospitalization.

The hospital now assigns pharmacy staff to record medical histories for certain high-risk patients admitted after seeking treatment in the emergency department. The process can involve reconciling electronic health records with prescription databases and written lists from the patient, his or her pharmacy, and the primary care provider, as well as verbally provided information.

“There can be a lot of CSI-type investigation,” said pharmacist Jesse Wisniewski, PharmD, who explained he sometimes spends 40 minutes or more taking medication histories for certain patients.

Jolynn Tumolo

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