• 6
    Jan
  • Best Possible Medication History in the Emergency Department: RESULTS

Of 120 patients identified during December 2008 as being eligible for inclusion, 60 were enrolled and 60 were assigned to not participate. Thirty of the enrolled patients were interviewed first by the pharmacist, and 30 patients were inter­viewed first by the technician. One of the patients interviewed was excluded from the analysis because both the patient and the patient’s spouse had severe cognitive dysfunction and confusion and were unable to provide the necessary information. For other patients who were either unable to communicate or who had cognitive dysfunction, information was gathered from caregivers or family members. A total of 59 patients were included in the final analysis (Table 1).

On the basis of interviews conducted with the 59 patients, the pharmacists had no unintentional discrepancies for prescription medications for 47 patients, and the technicians had no unintentional discrepancies of this type for 50 patients. The difference between the 2 groups was not statistically significant (p = 0.47) (Table 2). Similarly, the mean number of discrepancies per patient for prescription medications did not differ significantly between pharmacists and technicians (0.25 versus 0.24; p = 0.88). buy cialis soft tabs

Table 1. Characteristics of 59 Participants in a Study of Medication Reconciliation in the Emergency Department

Characteristic

No. (%) of Patients

Sex


Male


29 (49)


Female


30 (51)

Age (years)


Mean (SD)


61.3 (18.6)


Range


20-93

Time of enrolment

0800 to 1059


19 (32)

1100 to 1359


24 (41)

1400 to 1700


16 (27)

No. of medications per patient

Prescription


Mean (SD)


6.2 (4.6)


Range


0-16



Over-the-counter or herbal products


Mean (SD)


1.9 (1.8)


Range


0-10

SD= standard deviation.

The pharmacists had no unintentional discrepancies for over-the-counter medications for 52 patients, and the technicians had no unintentional discrepancies of this type for 53 patients. This difference was not statistically significant (p = 0.77) (Table 2). The mean numbers of discrepancies per patient for over-the-counter medications did not differ significantly between pharmacists and technicians (0.14 versus 0.15; p = 0.83) (Table 2).  viagra 50 mg

Table 2. Discrepancies for Prescription and Over-the-Counter Drugs

No. of Patients with Discrepancies*



Product Type



Pharmacist Performing Reconciliation



Technician Performing Reconciliation



Statistic



p

value



Prescription drugs

X2= 0.52, df (n=118)


= 1

0.47(Cramer’s V = 0.07)


No discrepancies


47


50

At least 1 discrepancy


12


9


Over-the-counter products

X2= 0.09, df (n=118)


= 1

0.77
(Cramer’s V
= 0.03)


No discrepancies


52


53


At least 1 discrepancy


7


6



Discrepancies per patient (mean ± SD)


Prescription drugs

0.25 ±0.54

0.24 ±0.68

t= 0.15,df


=


58

0.88

(-Л
2< 0.001)


Over-the-counter products


0.14 ±0.39


0.15 ±0.48


t= -0.22,
df
=


58


0.83



(-Л
2
= 0.001)


SD= standard deviation. *Except where indicated otherwise.

There was no significant difference in the mean number of discrepancies between the first and second interviews (t = —0.31, df = 58, p = 0.76, ‘2 < 0.002). Similarly, there were no statistically significant differences among the 3 pharmacists or between the 2 technicians in terms of discrepancies for prescription or over-the-counter medications.
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Table 3. Type and Potential Severity of Discrepancies* in Best Possible Medication Histories (BPMHs) Prepared by Pharmacists and Pharmacy Technicians

Type of Discrepancy

Class

1

Class

2

Class

3

Omission of prescription medication


In
BPMHs prepared by pharmacists
(6 patients)


2


5


0


In
BPMHs prepared by technicians
(4 patients)


3


1


0

Omission of over-the-counter or herbal product


In BPMHs prepared by pharmacists (6
patients)


6


1


0


In
BPMHs prepared by technicians


(5
patients)


7


0


0

Incorrect drug (prescription or over-the-counter)


In BPMHs prepared by pharmacists (1
patient)


0


0


1


In
BPMHs prepared by technicians


(1
patient)


1


0


0

Discrepant dose (prescription or over-the-counter)


In BPMHs prepared by pharmacists (3
patients)


1


1


1


In
BPMHs prepared by technicians


(2
patients)


1


1


0

Discrepant frequency

(prescription or over-the-counter)


In BPMHs prepared by pharmacists (5
patients)


3


2


0


IIn
BPMHs prepared by technicians


(8
patients)


5


4


0

*Class

1 =
unlikely to cause discomfort or deterioration, class 2



=
potential to cause discomfort or deterioration,

class 3 = potential to cause severe discomfort or deterioration.

The principal investigator identified various types of discrepancies, with various levels of severity, in the BPMHs prepared by pharmacists and technicians (Table 3). Evaluation of the BPMHs prepared by pharmacists revealed 12 class 1 discrepancies, 9 class 2 discrepancies, and 2 class 3 discrepancies (23 discrepancies total). The discrepancies with class 3 severity are summarized in Table 4. Review of the BPMHs prepared by technicians revealed 17 class 1 discrepancies, 6 class 2 discrep­ancies, and no class 3 discrepancies (23 total discrepancies). A weighted sum of errors was calculated for each patient, whereby each error was multiplied by its severity score, and values were summed for each patient. The mean weighted severity sum per patient for prescription medications did not differ significantly: 0.42 (standard deviation [SD] 0.95) for pharmacists and 0.34 (SD 0.94) for technicians (t = 0.50, df = 58, p = 0.62, ‘2 = 0.004). Similarly, the mean weighted severity sum per patient for over-the-counter medications did not differ significantly: 0.17 (SD 0.50) for pharmacists and 0.14 (SD 0.70) for technicians (t = 0.39, df = 58, p = 0.70, ‘Л2 = 0.003).
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Table 4. Descriptions of Discrepancies with Class 3 Severity

Patient Data

Medications

Discrepancy


77-year-old woman presenting to
emergency department with dysuria


Allopurinol, ASA, bisoprolol,
domperidone, furosemide, insulin, isosorbide dinitrate, lansoprazole,
nifedipine XL, paroxetine, rosuvastatin, valsartan, warfarin


Bisoprolol:

Blister package label read and transcribed by pharmacist as “bisoprolol

5

mg
tabs daily” Actual dosage as written on blister package label:
bisoprolol 5 mg


%

tab
daily


58-year-old man presenting to
emergency department with chest pain


Hydrochlorothiazide, ibuprofen,
nifedipine XL, propranolol LA



Atenolol


:


Documented by pharmacist as a


home medication Drug had been
discontinued before admission and replaced with propranolol


ASA= acetylsalicylic acid, LA = long-acting, XL = extended release.

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