I read the editorial by Howe that mentioned the risk to patient safety of medication reconciliation errors between hospitals and general practices.1 During my placements in hospitals, I noticed one of the most frequent errors is patients’ adverse drug reactions (ADR) not being properly documented. Patients are sometimes mistakenly given medications which had caused ADR in the past. It has been suggested that closer collaboration between doctors and pharmacists in primary care prevent ADR.2 In Oceania, data showed that patients’ charts reviewed by pharmacists were less likely to have inadequate documentations of ADR (13.5% versus 29.4%; P<0.001).3
Being an ex-pharmacist and now a medical doctor, I conducted a study that investigated how many ADRs were missed or incompletely documented in the admission medical notes in New Cross Hospital, Wolverhampton. From September to November 2013, I interviewed 109 consecutive adult inpatients, who were alert and oriented with Glasgow Coma Scale score of 15 (Table 1). Participants were interviewed using a list of questions adapted from a previously published questionnaire.4 Participants were asked to list any drugs they could not tolerate and describe the nature of reactions. The collected information was compared with the ADR history in the admission notes documented by doctors. Only reactions listed in standard texts (British National Formulary and Lexi-Comp®) are regarded as likely reactions.
Fifty-two of the 109 patients (47.7%) reported an ADR to at least one drug. ADR documentation was inadequate in 39 patient notes (35.8%): absent in 20 and without the nature of the reaction in 19. The result in the current study was comparable to the 29.4% of inadequate ADR documentations when pharmacists were not involved found in the Oceanian study.3 These suggest that pharmacist involvement in drug history-taking and ADR assessment can potentially reduce medication errors. This hypothesis needs to be validated with prospective studies and should include pharmacist involvement and better education in therapeutics and in communication skills. Having more pharmacist involvement in hospital and primary care could improve medication reconciliation.
- © British Journal of General Practice 2015