Variation in medication information for elderly patients during initial interventions by emergency department physicians

Abstract

Discrepancies between medication information received from elderly patients in the emergency department (ED) at the time of initial diagnosis or therapeutic intervention and information collected by pharmacists from outside caregivers (pharmacies and physicians) were studied. The time from patient arrival at the ED to initial intervention was also studied. Written and oral medication histories of ED patients 65 years and older who were seen at an urban academic hospital between June 2003 and May 2004 were collected and represented information available at the time of initial diagnosis and treatment. A clinical pharmacist contacted all relevant physicians and pharmacies identified in the ED and compiled for each patient a medication profile. The times of ED arrival and initial intervention were recorded. For the 98 patients included, the mean discordance in drug names between the two resultant types of drug list exceeded 30%. The classes of medications that varied most frequently included antihypertensives, supplements, analgesics, nitrates, and antiplatelets and anticoagulants. The median time from patient entry to initial diagnostic intervention was 37 minutes, with a range from 1 to 599 minutes. The median time from patient entry to initial therapeutic intervention was 81.5 minutes, with a range from 8 to 598 minutes. A pilot study demonstrated that approximately one third of elderly patients' medication information available to the ED physician at the time of the initial diagnostic and therapeutic intervention differed from that obtainable from outside caregivers.