Pharmacist elicited medication histories in the Emergency Department: Identifying patient groups at risk of medication misadventure
The Australian Pharmaceutical Advisory Committee guidelines call for a detailed medication history to be taken at the first point of admission to an Emergency Department (ED). The elderly, in particular those residing in Residential Aged Care Facilities and those with a non-English speaking background, have been identified as patient groups vulnerable to medication misadventure.
Objective: to analyse the incidence of discrepancies in medication histories in these demographic groups when pharmacist elicited medication histories were compared with those taken by ED physicians. It also aimed to investigate the incidence of medication related ED presentations.
Methods: The study was conducted over a six week period and included 100 patients over the age of 70, who take five or more regular medications, have three or more clinical co-morbidities and/or have been discharged from hospital in three months prior to the study.
Results: Twenty four participants were classified as ‘language barrier’; 12 participants were from residential aged care facilities, and 64 participants were classified as ‘general’. The number of correctly recorded medications was lowest in the ‘language barrier’ group (13.8%) compared with 18% and 19.6% of medications for ‘general’ patients and patients from residential aged care facilities respectively. Seven of the patients (29.2%) with ‘language barrier’; 1 from a residential aged care facility (8.3%) and 13 of the (20.3%) patients from the ‘general’ category were suspected as having a medication related ED presentation.
Conclusion: This study further highlights the positive contribution an ED pharmacist can make to enhancing medication management along the continuum of care. This study also confirms the vulnerability of patients with language barrier to medication misadventure and their need for interpreter services at all stages of their hospitalisation, in particular at the point of ED presentation.
2. Col N, Fanale JE, Kronholm P, The role of medication non-compliance and adverse drug reactions in hospitalisations of the elderly. Arch Intern Med 1990;150:841-5.
3. Malhoutra S, Karan RS, Pandhi P, Jain S, Drug related medical emergencies in the elderly: role of adverse drug reactions and non-compliance. Postgrad Med J 2001;77:703-7.
4. Grymonpre RE, Mitenko PA, Sistar DS, Aoki FY, Montgomery PR, Drug-associated hospital admissions in older medical patients. J Am Geriatr Soc 1988;36(12):1092-8.
5. Mannesse CK, Derkx FH, de Ridder MA, Man in 't Veld AJ, van der Cammen TJ, Contribution of adverse drug reactions to hospital admission of older patients. Age Ageing 2000;29(1):35-9.
6. Gurwitz JH, Field TS, Harrold LR, Rothschild J, Debellis K, Seger AC, Cadoret C, Fish LS, Garber L, Kelleher M, Bates DW, Incidence and Preventability of Adverse Drug Events among Older Persons in the Ambulatory Setting. JAMA 2003; 2889(9):1107-16.
7. Rochon PA Gurwitz JH, Optimising drug treatment for elderly people: the prescribing cascade. BMJ 1997;315:1096-99.
8. Chan M, Nicklason F, Vial J, Adverse drug events as a cause of hospital admission in the elderly. Intern Med J, 2001;31:199-205.
9. Chung MK Bartfield JM, Knowledge of Prescription Medications Among Elderly Emergency Department Patients. Ann Emerg Med 2002;39(6):605-8.
10. Welch S, The Evolving Area of Emergency Medicine Pharmacy. Aust J Hosp Pharm 1997;27:325-7.
11. Australian Pharmaceutical Advisory Council, Guiding Principles to achieve continuity in medication management. 2005, Canberra: Commonwealth of Australia.
12. Dodds LJ, An objective assessment of the role of the pharmacist in medication and compliance history taking. British Journal of Pharmaceutical Practice, 1982;4:12-23.
13. Crook M, Ajdukovic M, Angley C, Soulsby N, Doecke C, Stupans I, Angley M, Eliciting comprehensive medication histories in the emergency department: the role of the pharmacist. Pharm Pract (Internet) 2007;5(2):78-84.
14. McFadzean E, Isles C, Moffat J, Norrie J, Steward D, Is there a role for a prescribing pharmacist in preventing prescribing errors in a medical admission unit? Pharm J 2003;270:896-9.
15. Hohl CM, Robitaille C, Lord V, Dankoff J, Colacone A, Berard A, Pepin J, Afilalo M, Emergency Physician Recognition of Adverse Drug-related Events in Elder Patients Presenting to an Emergency Department. Acad Emerg Med 2005;12(3):197-205.
16. Hohl CM, Dankoff J, Colacone A, Afilalo M. Polypharmacy, Adverse Drug-Related Events, and Potential Adverse Drug Interactions in Elderly Patients Presenting to an Emergency Department. Ann Emerg Med 2001;38(6):666-71.
17. Fejzic JB, Tett SE. Medication management reviews for people from the former Yugoslavia now resident in Australia. Pharm World Sci 2004;26(5):271-6.
18. Baker DW, Parker RM, Williams MV, Pitkin K, Parikh NS, Coates W, Imara M. The health experience of patients with low literacy. Arch Fam Med 1996;5(6):329-34.
19. Jacobs EA, Lauderdale DS, Meltzer D, Shorey JM, Levinson W, Thisted RA. Impact of Interpreter Services on Delivery of Health Care to Limited-English-Proficient Patients. J Gen Intern Med 2001;16(7):468-74.
20. Baker DW, Parker RM, Williams MV, Clark WS. Health Literacy and the Risk of Hospital Admission. J Gen Intern Med 1998;13(12):791-8.
21. Bond CA, Raehl CL, Franke T. Clinical Pharmacy Services, Pharmacy Staffing, and the Total Cost of Care in United States Hospitals. Pharmacotherapy 2000;20(6):609-21.
22. Bond CA, Raehl CL, Franke T. Clinical Pharmacy Services and Hospital Mortality Rates. Pharmacotherapy 1999;19(5):556-64.
23. Cheek J, Gilbert A, Ballantyne A, Penhall R. Factors influencing the implementation of quality use of medicines in residential aged care. Drugs Aging 2004;21(12):813-24.
24. Peterson G, Jackson S. Too many holes in the cheese when medication misadventure results in patient harm. Australian Pharm 2004;23(11):782-7.
25. Roughead EE, Gilbert AL, Primrose JG, Sansom LN. Drug-related hospital admissions: a review of Australian studies published 1988-1996. Med J Aust 1998;168(8):405-8.
26. Roughead L, Gilbert A, Medication misadventure. Australian Pharmacist 2002;21(2):90-4.
27. Department of Health and Aging. Medicare Benefits Schedule item 903. 2006 [cited 2006 viewed May15 ]; Available from:
28. Rossi S, ed. Australian Medicines Handbook. ed. Rossi S. 2005, Australian Medicines Handbook: Adelaide.
29. Gilbert AL, Roughead EE, Beilby J, Mott K, Barratt JD. Collaborative medication management services: improving patient care. Med J Aust 2002;177(4):189-92.
30. Cipolle RJ, Strand LM, Morley PC, Pharmaceutical Care Practice. New York: McGraw-Hill; 1998.
31. Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, Janecek E, Domecq C, Greenblatt DJ. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 1981;30(2):239-45.
32. Australian Bureau of Statistics (2001) Older People, Australia: A Social Report, Chapter four: economic environment.
33. Baker DW, Parker RM, Williams MV, Coates WC, Pitkin K. Use and effectiveness of interpreters in an emergency department. JAMA 1996;275(10):783-8.
34. Hornberger JC, Gibson CD Jr, Wood W, Dequeldre C, Corso I, Palla B, Bloch DA. Eliminating language barriers for non-English-speaking patients. Med Care 1996;34(8):845-56.
35. Hornberger J, Itakura H, Wilson SR. Bridging language and cultural barriers between physicians and patients. Public Health Rep 1997;112(5):410-7.
36. Bajramovic J, Tett S. Problems of pharmacy communication in multicultural Australia. Australian Pharmacist, 2000;19(7):430-4.
37. Emblen G, Miller E. Home Medicines Review: the how and why for GPs. Aust Fam Physician 2004;33(1-2):49-51
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