Abstract
Objective
Medication reconciliation results in fewer adverse drug events. The first step in medication reconciliation is to carry out a structured interview about medication use. It is not known whether such an interview is useful in inpatient old age psychiatry. The object of this study was to determine at admission the number of discrepancies in medication use, comparing the structured history of medication use (SHIM) procedure with the usual procedure for taking the medication history.
Methods
A prospective observational study was conducted. All consecutive patients aged 55 years and older admitted from January until April 2011 to the inpatient old age psychiatric clinic of a large psychiatric teaching hospital in The Hague, the Netherlands, were eligible for inclusion; 50 patients were included. In every patient, the usual procedure (medication history-taking at admission by the treating physician) was compared with the SHIM procedure administered by the researcher. The SHIM procedure consists of a structured interview with the patient about the actual use of medication, incorporating the information from the community pharmacy and the patient’s medications brought to the interview. The main outcome was the number of discrepancies in recorded medication use between the SHIM and the usual procedure.
Results
In total, 100 discrepancies (median 2 per patient, range 0–8) in medication use were identified; 78 % (n = 39) of the patients had at least one discrepancy. Of the discrepancies, 69 % were drug omissions, and 31 % were drug additions or discrepancies in the frequency or dosage of medications. Eighty-two percent of all discrepancies were potentially clinically relevant. In 24 % of the patients, the discrepancies had clinical consequences.
Conclusion
The number of discrepancies that were found suggests that the usual procedure for taking the medication history can be improved. The SHIM procedure enables a comprehensive and accurate overview of the medication used by older patients admitted to a psychiatric hospital, and contributes to the prevention of clinically relevant adverse drug events.
References
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.
Dobrzanski S, Hammond I, Khan G, et al. The nature of hospital prescribing errors. Br J Clin Govern. 2002;7:187–93.
Lau HS, Florax C, Porsius AJ, et al. 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.
Cornish PL, Knowles SR, Marchesano R, et al. Unintended medication discrepancies at the time of hospital admission. Arch Intern Med. 2005;28(165):424–9.
Steurbaut S, Leemans L, Leysen 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.
Rozich JD, Howard RJ, Justeson JM, et al. Standardization as a mechanism to improve safety in health care. Jt Comm J Qual Saf. 2004;30:5–14.
Michels RD, Meisel SB. Program using pharmacy technicians to obtain medication histories. Am J Health Syst Pharm. 2003;60:1982–6.
Rodehaver C, Fearing D. Medication reconciliation in acute care: ensuring an accurate drug regimen on admission and discharge. Jt Comm J Qual Patient Saf. 2005;31:406–13.
Glintborg B, Hillestrom PR, Olsen LH, et al. Are patients reliable when self-reporting medication use? Validation of structured drug interviews and home visits by drug analysis and prescription data in acutely hospitalized patients. J Clin Pharmacol. 2007;47:1440–9.
Divakaran VG, Murugan AT. Polypharmacy: an undervalued component of complexity in the care of elderly patients. Eur J Intern Med. 2008;19:225–6.
Drenth-van Maanen AC, Spee J, Marum van RJ, et al. Structured history taking of medication use reveals iatrogenic harm due to discrepancies in medication histories in hospital and pharmacy records. J Am Geriatr Soc. 2011;59:1976–7.
Procyshyn RM, Barr AM, Brickell T, et al. Medication errors in psychiatry: a comprehensive review. CNS Drugs. 2010;24:595–609.
Maidment ID, Haw C, Stubbs J, et al. Medication errors in older people with mental health problems: a review. Int J Geriatr Psychatr. 2008;23:564–73.
Morcos S, Francis SA, Duggan C. Where are the weakest links? A descriptive study of discrepancies between primary and secondary sectors of mental health service provision. Psychiatr Bull. 2002;26:371–4.
Naranjo CA, Busto U, Sellers EM, et al. A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther. 1981;30:239–45.
Stubbs J, Haw C, Taylor D. Prescription errors in psychiatry—a multi-centre study. J Psychopharmacol. 2006;20:553–61.
Stubbs J, Haw C, Cahill C. Auditing prescribing errors in a psychiatric hospital: are pharmacists interventions effective? Hosp Pharmacist. 2004;11:203–6.
Acknowledgments
Funding for initial development of the SHIM was provided by the Netherlands Organization for Health Research and Development (ZonMW).
The authors of this article have no conflicts of interest to declare.
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Prins, M.C., Drenth-van Maanen, A.C., Kok, R.M. et al. Use of a Structured Medication History to Establish Medication Use at Admission to an Old Age Psychiatric Clinic: A Prospective Observational Study. CNS Drugs 27, 963–969 (2013). https://doi.org/10.1007/s40263-013-0103-9
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DOI: https://doi.org/10.1007/s40263-013-0103-9