Background: Accurate medication histories reduce the likelihood of medication errors in patients being admitted to the hospital. Medication histories can inform inpatient providers of what medications the patient is taking prior to the emergency department encounter. Existing literature corroborates that pharmacist involvement in the medication history process leads to less discrepancies. Regarding patients in the emergency department with behavioral health problems, pharmacists are ideally qualified to collect accurate medication histories in this patient population. At our institution, medication histories for behavioral health patients are nursing-led. The purpose of this study is to determine the accuracy of medication histories collected for behavioral health patients in the emergency department.
Methodology: Over a specified 4-month period, patients admitted to the behavioral health units of CaroMont Regional Medical Center’s emergency department (ED) had their medication histories performed by a member of the pharmacy team following completion by nursing staff. Patients aged 18 years or older roomed in behavioral health areas of the ED with a medication history completed by nursing staff were eligible for inclusion. Pregnant and incarcerated patients were excluded. For each patient, investigators utilized interviews with the patient or patient’s caregiver(s), prior to encounter medication lists, medication dispense histories, facility medication administration records, and telephone consultations with primary care providers, pharmacies, or facilities to collect information regarding a patient’s prior to encounter medications. Investigators then compared findings from the pharmacist-completed medication histories to the medication history completed by nursing staff. Any discrepancies between medication histories were collected as data and corrected in the electronic medical record. Additional data collected included patient demographics, reason for emergency department visit, and time taken to complete each medication history. Primary endpoint data were reported descriptively for the number of discrepancies across the cohort. Secondary endpoint data were reported descriptively for number of prior to encounter medications per patient, number of discrepancies per patient, and types of discrepancies (including omissions/erroneous exclusions, commissions/erroneous inclusions, drug name errors, drug formulation errors, drug dose errors, and drug regimen errors).
Results: During the specified data collection period, 92 patients were screened. Thirty patients had prior to encounter medications reviewed. Female sex accounted for 53.3% of patients and median age was 34 years. Reasons for exclusion are described below.
Exclusion Reason n (%) Chief Complaint not Psychiatric 51 (82.1) Patient Admitted 5 (8.3) Patient Discharged 2 (3.2) Patient Condition 2 (3.2) Prior to Encounter Medications Reviewed by PTA Technician 1 (1.6) Prior to Encounter Medications Not Reviewed by Nursing During Encounter 1 (1.6)
Across the 30 patients whose prior to encounter medications were reviewed, 71 discrepancies were identified- an average of 2.33 discrepancies per patient. Patients had an average of 6.23 prior to encounter medications, and the average time for medication history completion was 6.13 minutes. The specific type of discrepancies among the 71 identified are broken down in the table below.
Discrepancy Type n (%) Commission 31 (43.1) Omission 21 (29.9) Regimen 9 (12.8) Dose 8 (11.4) Formulation 2 (2.8) Name 0 (0)
Conclusion: Based on our findings, pharmacy personnel are in a position to optimize the detection and correction of discrepancies following an initial nursing driven review of behavioral health patients’ prior to encounter medications. Due to the nature of how the study was conducted, limitations of this study include that it cannot be determined how many discrepancies were already corrected by nursing personnel, or how many discrepancies were not identified by investigators. Additional limitations are that the mental state of patients may have contributed to inadequate histories, as well as previous medication changes having gone undetected during transfers to other care areas.
