Added value of pharmacist-acquired drug histories in an orthopaedic ward.

In Belgian hospitals, drug histories of patients taken on admission are generally collected by medical trainees, physicians and nurses. As errors in drug histories may lead to medication errors and adverse drug events, we aimed at comparing the data obtained by a clinical pharmacist with those obtained by the nurses in a surgical orthopaedic ward. In this four months study, 50 patients, with a mean age of 66 years, were included. Out of these 50 drug histories, 107 differences were found when comparing the data gathered by the nurses with the data of the pharmacist. On average, there were 2.1 discrepancies per patient. Omission of a drug and incorrect or unknown dose accounted for 80.3% of the discrepancies, while allergy and/or intolerance, incorrect frequency and addition of a drug accounted for respectively 11.2%, 4.8% and 3.7%. Interestingly, six drug categories represented almost 55% of the drug-related discrepancies.These were, in order of importance: anxiolytic and neuroleptics, antacids and proton pump inhibitors (PPI's), painkillers, antidepressants, aspirin and eye drops. Finally, 27% of the discrepancies concerned "over the counter" drugs. From this study we were able to conclude that the clinical pharmacist performed more complete and more accurate drug histories than nurses in the surgical orthopaedic care unit, especially in patients taking multiple drugs. These results suggest that drug histories taken by a pharmacist may lead to a reduction of potential adverse drug events during hospitalisation.