Comparison of electronic pharmacy prescription records with manually collected medication histories in an emergency department

Abstract

Study objective: Medication history is an essential part of patient assessment in emergency care. Patient-reported medication history can be incomplete. We study whether an electronic pharmacy-sourced prescription record can supplement the patient-reported history.

Methods: In a community hospital, we compared the patient-reported history obtained by triage nurses to a proprietary electronic pharmacy record in all emergency department (ED) patients during 3 months.

Results: Of 9,426 triaged patients, 5,001 (53%) had at least 1 (mean 7.7) prescription medication in the full-year electronic pharmacy record. Counting only recent prescription medications (supply lasting to at least 7 days before the ED visit), 3,688 patients (39%) had at least 1 (mean 4.0) recent medication. After adjustment for possible false-positive results, recent electronic prescription medication record enriched the patient-reported history by 28% (adding 1.1 drugs per patient). However, only 60% of patients with any active prescription medications from either source had any recent prescription medications in their electronic pharmacy record.

Conclusion: The electronic pharmacy prescription record augments the manually collected history.

Figure 1

Dispensing of each medication over time. Each red, horizontal line represents a single new prescription or refill, and its length represents the calculated duration of the supply dispensed. We considered any medication with a duration line that crossed the blue dashed vertical line (end of supply is within 7 days of ED visit) to be a recent medication. The document lists the prescribers for each medication. This example patient had 6 different prescribers (fictitious names shown), 13 medications of which the first 3 were considered recent. This report is produced by the NLM/Health Level Seven server and is not the native report delivered by Surescripts.

Figure 2

Overlap among patients with an ED history (red circle), a recent electronic history (blue circle), and a full-year electronic history (yellow circle) for prescription medications.