Medication histories: does anyone know what medicines a patient should be taking?

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Abstract
Objective: To determine and evaluate the accuracy of physician-acquired medication histories for patients admitted to the surgical and medical admission units in a large teaching hospital in the UK. Method: The pharmacist obtained a medication history, including allergy status, by interviewing the patient. This was compared with the physician's history as documented in the medical notes and with a third source, for example general practitioner (GP) records, and then with what was prescribed on the inpatient prescription chart. Key findings: In total, 126 medical patients and 51 surgical patients were reviewed. 102 (17%) medicines were prescribed on the inpatient chart but not documented in the medical notes; 179 (16.7%) medicines were documented in the notes but not prescribed on the prescription chart, with no explanation by the doctor; 75 (9.8%) medicines were documented in the notes by doctor with no dose; 227 (41%) medicines from pharmacist interview were not prescribed on the chart; 189 (34.1%) medicines were identified from pharmacist interview but not recorded in the notes; 113 (28.9%) medicines from pharmacist interview had a dose that was different in the notes; 45 (12.8%) medicines from pharmacist interview had a dose that was different on the chart; and 103 (21.1%) medicines from pharmacist interview had a dose different from that in the third source. A total of 51 medicines were identified from the pharmacist interviews that were not on the records of the GP or nursing home, and these accounted for approximately 5% of all medicines recorded. Conclusion: This study supports the findings of previous studies that there are substantial numbers of discrepancies between documented sources of patients' medicines and what patients report they are taking. Furthermore our findings add to existing knowledge by highlighting the need for clearer and more complete documentation of medication histories in the patient's medical notes. The inaccuracies observed with GPs' records and in comparison with hospital records suggest that currently there is no ‘gold standard’ medication history available, other than a list of drugs taken from a patient who is perceived to be ‘reliable’.