Bringing patients' own medications into an emergency department by ambulance: Effect on prescribing accuracy when these patients are admitted to hospital

Abstract

Objective: To determine whether the availability of patients' own medications (POM) in emergency departments (EDs) results in decreased prescribing errors of patients' usual medications on admission. Design, participants and setting: Observational study of patients presenting by ambulance to the ED of Austin Hospital, a Melbourne metropolitan teaching hospital, between 13 and 31 March 2006. Patients were enrolled if they were brought to the ED by ambulance, aged 18 years or older, taking four or more regular medications, admitted to hospital, and not referred to a pharmacist before the admission medication chart was written. ED pharmacists determined patients' regular medications and details of medications brought in by ambulance. Admission medication charts were assessed and discrepancies were recorded as prescribing errors if a change was made after a pharmacist discussed the discrepancy with the prescriber. Main outcome measures: Percentage of medications correctly prescribed when POM were brought in to the ED compared with when they were not; the nature and frequency of prescribing errors on admission. Results: 100 patients were enrolled; they were taking 4-17 regular medications (mean, 8.0; SD, 3.7). Among the 428 POM that were brought to the ED, 56 errors occurred (13.1%); and among the 372 regular medications taken by patients for whom POM were not brought in, 95 errors occurred (25.5%) (difference in percentages, 12.4%; 95% CI, 6.7%-18.0%; P < 0.001). The most prevalent prescribing errors were omissions (40.4%), and most errors (72.8%) were classified as of "moderate" clinical significance. Conclusions: When POM were brought to the ED by paramedics, significantly fewer errors occurred on admission medication charts. An intervention program to encourage paramedics to bring POM to the ED is indicated.