Background and Importance Obtaining the Best Possible Medication History (BPMH) is an essential step in the medication reconciliation process, that should ideally be based on the most appropriate sources of information, such as patient health records, to which access is often limited. Implementation of a National Electronic Health Record (NEHR) system aims at streamlining this process by converging relevant data into a singular database.
Aim and Objectives This research aimed to assess the added value of NEHR to BPMH. In addition, the quality of NEHR-based BPMH was compared to the former physician/nurse-led Standard of Care (SoC), in order to explore the added value of clinical pharmacy services in obtaining BPMHs.
Material and Methods The study took place between 05.2022-08.2022 in the general surgery department of a county hospital, enrolling patients over 18 years of age, admitted from their homes, with at least one regularly taken prescribed medication and without major communication difficulties. Medication reconciliation was initiated by clinical pharmacists, based on the documentation available at the point-of-care (‘Hospital list’), which in turn got validated via NEHR data (‘NEHR list’), with the final step being a patient interview, formulating the final medication list (‘BPMH list’). Primary outcome metrics were the frequency and types of medication discrepancies derived from the comparison of the aforementioned lists, including the former SoC.
Results The study included 100 patients (52% female, average age=62 years). 231 discrepancies were found between the NEHR list and the Hospital list (median=2; IQR=4), 64% of the patients being affected. The most common discrepancy was drug omission (65%) and incorrect daily dose (26%). There was an inconsistency between the BPMH list and the SoC in 90% of the patients (median=3; IQR=3), the most common errors being drug omission (41%) and incorrect daily dose (31%).
Conclusion and Relevance Based on these results, the NEHR can contribute to the compilation of a more prudent BPMH due to its more comprehensive data content. This methodology may, in turn, facilitate the prevention of multiple medication-related errors. These outcomes also underline the legitimacy of pharmacists' access to such national systems.
Conflict of Interest No conflict of interest
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