MULTIPRONGED APPROACH TO OBTAIN A MEDICATION HISTORY FOR OLDER ADULTS IN THE ACUTE CARE SETTING

Abstract

Hospitalized older adults have a high prevalence of polypharmacy. Gathering an admission medication history is necessary but often challenging. We describe the process and value of a multipronged approach to obtain an accurate medication history for hospitalized older adults enrolled in a randomized controlled trial to reduce patients’ medication burden. Our multipronged approach started with the pre-admission list and other outside medical records in the patient’s chart followed by a structured patient/surrogate interview to identify their prescribers, pharmacies and other medications they are taking regularly. Subsequently, each medication was reconciled with the pharmacies’ refill history and the controlled substance database. To date, we have enrolled 126 participants (mean age of 78 ± 10). On average, participants had 2.9 ± 1.3 prescribers and utilized 1.5 ± 0.6 pharmacies. Overall, total medications prior to hospitalization from all sources averaged 16.2 ± 6.0 per patient. Pharmacy refill history and patient/surrogate interview revealed an average of 0.9 ± 1.5 and 0.8 ± 1.4 medications per patient, respectively, that were previously unknown to the hospital treatment team. Additionally, pharmacy refill history revealed an average of 0.9 ± 1.7 medications per patient that had not been filled by the patient for the last three months but were considered active per the hospital treatment team. Even when the medication data sources agreed, there was a dose discrepancy for an average of 0.7 ± 1.2 medications per patient. In conclusion, no one information source provides an accurate medication history. Thus, a multipronged approach is necessary to identify medication discrepancies that have substantial implications for safe prescribing in the hospital setting.