Accuracy of Best Possible Medication Histories Collected by Nurses in Pre-Surgical Screening of Elective Surgery Patients

Abstract

Rationale: Obtaining an accurate Best Possible Medication History (BPMH) is the foundation of Medication Reconciliation (MedRec), a practice that reduces medication errors and patient harm. At Kingston Health Sciences Centre (KHSC), nurses obtain BPMH for elective surgery patients during a Pre-Surgical Screening (PSS) appointment. The PSS BPMH is used by surgeons to generate orders for home medications at the time of admission. The accuracy of PSS BPMHs has not been studied and could be affected by the adequacy of training provided to nurses and purposeful changes to medications made between the time of PSS and surgery. Methods: A prospective, non-randomized comparison was used to determine the accuracy of PSS BPMHs. A pharmacy resident obtained BPMHs during the post-operative period for a convenience sample of 60 elective surgery patients. For each patient, the PSS BPMH was retrieved and compared with the pharmacy-obtained BPMH. Discrepancies between medication regimens were recorded and classified by type and risk of patient harm. Results: 31% of medication regimens contained discrepancies between the PSS and pharmacy-obtained BPMHs, with an average of 2.55 discrepancies per patient. Of these, 4.6% were judged to carry risk of moderate harm to the patient and 95.6% carried little to no risk of harm. No discrepancies which posed a risk of severe harm were identified. 60% of discrepancies were related to non-prescription medications. 21% of discrepancies resulted from a purposeful medication change during the time between PSS and surgery. Conclusion: While the rate of discrepancies between BPMHs was high, the majority of discrepancies carried little to no risk of harm. Elective surgery patients are unlikely to experience clinically important medication errors secondary to use of the nursing-obtained PSS BPMHs in the current model of MedRec at KHSC.