Background Medicines lists are often incomplete, with a lot of discrepancies, which may lead to adverse drug events during hospitalisation and after discharge. In Denmark no single electronic system contains all medicines information on a patient, and nurses and doctors spend a lot of time trying to obtain a current medicines list when a patient is admitted. In Denmark no attempts have been made to reduce these discrepancies by a pharmacist contacting the patient by telephone before the admission.
Purpose To investigate whether the clinical pharmacist improve the safety of drug treatment by obtaining the medicines list in collaboration with the patient before admission and by asking patients to bring their own regular medicine (s).
Materials and methods A few days before planned admission, the pharmacist made a presumed medicines list of the patient’s regular medicines by comparing the Electronic Medical Module, Electronic Patient Record and Pharmacy Dispensing Records. The patient was contacted by the pharmacist by phone to confirm the medicine regimen and to discuss compliance and possible medicines-related problems. In addition the pharmacist asked the patient about their use of over-the-counter drugs and herbal medicine. The discrepancies were defined as differences between the Electronic Medical Module and the actual current medicines list made by the pharmacist in collaboration with the patient. Additionally, patients were asked to bring their own medicines to prevent lack of treatment during hospitalisation due to stock content. The study was performed over 10 weeks.
Results The pharmacist attempted to call 102 patients and 78% answered the phone. In total 151 discrepancies were found, and 99% of the patients brought their own medicines when admitted.
Conclusions Contacting the patients by telephone before admission identified several discrepancies and led to obtaining a valid current medicines list. Secondary, by bringing their own medicines, lack of treatment during hospitalisation was prevented.
No conflict of interest.
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