Quel est l'apport d'un formulaire et du pharmacien pour obtenir une liste correcte et complète de la médication du patient dans un service d'urgence ? Etude rétrospective URGPHA.

Details

Supervisors

Caryn, Victoire ; Aghamohammad, Sanaz

Faculty

Faculté de pharmacie et des sciences biomédicales

Degree label

Master de spécialisation en pharmacie hospitalière

Abstract

BACKGROUND: Inaccurate and incomplete medication histories (MH) are a real problem in the emergency departments and can lead to potential adverse drug events. However, due to a lack of resources, a pharmacist-acquired best possible medication history (BPMH) cannot be made for each patient. The authors assessed if a patient self-administered MH form helps physicians obtain the BPMH and reduce discrepancies. The primary objective of this study is to compare the MH obtained by the emergency physician (EP) in two groups: without/with a patient self-administered MH form. METHODS: A retrospective cohort study is conducted in the emergency department at the Clinique Saint-Jean in Brussels, Belgium. Data from two periods are analyzed: 1) from October 2021 to January 2022 where the MH was obtained without the MH form; 2) from February 2022 to March 2022 where MH was obtained with the MH form. For each group, the EP’s BPMH is compared with the one from the pharmacist (=gold standard) and the mean number of discrepancies per patient is measured. The secondary outcomes are to determine population characteristics contributing to discrepancies and to measure whether a pharmacist-acquired MH increases the number of complete medications per patient. RESULTS: Medical records from 157 patients were analyzed (group 1: 79 patients, group 2: 78 patients). The median number of discrepancies per patient was 4 (min.0; max.18) in group 1 and 3 (min.0; max.15) in group 2 (p=0,93). A high number of medications taken at home was associated with a greater number of discrepancies. In both groups, the most common discrepancy was drug omission. The most common ATC classes involved in discrepancies were the cardiovascular system, nervous system and alimentary tract/metabolism because of their frequent use but also the respiratory and musculoskeletal systems. In group 1, the pharmacist obtained a median of 6,1 (min.1; max.13) complete drugs versus 2,8 (min.0; max.11) for the physician (p<0,001). In group 2, the median number of complete drugs was 4,6 (min.1; max.16) and 1,8 (min.0; max.11) respectively (p<0,001). CONCLUSION: The patient self-administered MH form did not significantly improve the accuracy and completeness of MH performed by the emergency physicians. However, this study highlighted the role of the pharmacist in obtaining a correct and accurate medication list compared to emergency physicians. Further research is needed to raise physicians’ awareness and involve patients themselves in the process of acquiring the best possible medication history.