Patient files


Medication errors occur with disturbing frequency and are a leading cause of morbidity and mortality in patients who have been admitted to hospital. More than half of all hospital medication errors occur at the interfaces of care, with over one-quarter of all hospital prescribing errors attributed to incomplete medication histories obtained at the time of admission. Cornish and others found that 53.6% of general medicine patients had at least one unintended medication discrepancy at the time of hospital admission, the most common type being the omission of a regularly scheduled medication. Over a third of these discrepancies had the potential to cause moderate to severe harm. These results are comparable to those obtained in previous studies. For example, Beers and others interviewed 122 elderly inpatients and found that 60% of the study population had one or more discrepancies on admission. Lau and others found that 26% of the prescription medications that patients were taking before admission were not recorded in their hospital records.

Obtaining an accurate medication history at the time of hospital admission is critical to ensuring safe and effective patient care. Incomplete or inaccurate medication histories may lead to unintended discontinuation of a medication, unnecessary drug therapy, and/ or failure to detect drug-related problems. canada drugs pharmacy

Obtaining a complete and accurate medication history can be difficult, given the many factors that affect the accuracy and completeness of the information, such as time available to conduct the interview, severity of the patient’s illness, patient’s cognitive status, patient’s familiarity with his/her medication regimen, availability of medication vials and/or a medication list, and presence of language barriers. The experience and training of the interviewer can be another factor. Without a formalized process for gathering the information, the reliability and validity of the history can be questionable.

Options for improving the accuracy and reliability of medication histories obtained at the time of admission have been investigated. These options include providing further training for admitting physicians and other health care personnel and integrating computer systems to allow the transfer of prescription drug information between community and hospital pharmacies.

The Pharmaceutical Information Program (PIP) was developed in Saskatchewan and introduced in fall 2005. It is a comprehensive database of dispensing records provided by the Saskatchewan Drug Plan. It enables approved health care providers to access prescription medication information for all residents of Saskatchewan who hold a current Saskatchewan health card, regardless of their age. The profile reflects historical information on medications dispensed, to a maximum of 1 year. The following medications are not listed in a patient’s PIP profile: medications prescribed, dispensed, and administered in hospital; medications covered by the Saskatchewan Cancer Agency or the Tuberculosis Control Program; investigational or study medications; medication samples; over-the-counter medications purchased without a prescription; and herbal products. In addition, out-of-province pharmacies located on the Saskatchewan border are not required to send their information to the Saskatchewan Drug Plan. cialis professional

The Saskatoon Health Region plans to use the provincial drug database to obtain PIP profiles for patients admitted to the hospital; it also plans to download PIP information to a medication reconciliation form that will be completed at the time of admission. However, the accuracy of the PIP profile in relation to patients’ actual medication use before admission has never been investigated. We undertook a study to quantify the extent of agreement between the PIP profile and the Best Possible Medication History (BPMH; obtained by a pharma­cist) for individual patients in determining patients’ medication use at the time of admission to hospital. The study objectives were to determine the accuracy and effectiveness of the PIP for determining a patient’s use of prescription medications immediately before admission, to identify any discrepancies between the patient’s PIP profile and his or her BPMH as obtained by a pharmacist, to categorize any medication discrepancies identified between the patient’s PIP profile and the BPMH, and to quantify the workload required for the pharmacist to obtain the BPMH.