title: Accuracy of the medication history at admission to hospital in Saudi Arabia.
abstract: OBJECTIVE
  Inaccurate medication history at admission to hospitals leads to preventable adverse drug events, which in turn increase mortality, morbidity, and health care costs. The objective of this study was to investigate the role of pharmacists in identifying discrepancies in medication histories at admission to a tertiary referral hospital in Saudi Arabia.
  
  
  METHODS
  We performed a prospective observational study in a 1200 bed tertiary hospital in Riyadh, Saudi Arabia. Patients were included if they were aged 16 years or older, were taking 5 or more medications, and were able to communicate or were accompanied by a caregiver who could communicate. Over 2 months in 2009, a pharmacist interviewed patients to ascertain all medications used prior to hospitalization, then all discrepancies were discussed with the admitting physician and unintended discrepancies were reported as errors.
  
  
  RESULTS
  A pharmacist interviewed 60 patients who were taking 564 medications total. Of these patients, 65% were male, and their mean age was 62. Patients were taking an average of 9.4 medications. Twenty-two (37%) patients had at least one discrepancy, with the most common being omissions of medications (35%) and dosage errors (35%). The mean age for patients with discrepancies was 64.6 years, and without discrepancies, 60.8 years (P = 0.37).
  
  
  CONCLUSIONS
  Inaccurate medication history at admission to a hospital was common in Saudi Arabia. This has the potential to cause harm to patients if it remains undetected. Pharmacists could potentially play a major role in obtaining this medication history at the time of hospital admission.
authors: Pharmacy Department, Riyadh Military Hospital, Riyadh, Saudi Arabia.
authors: Bishr H
authors: BH
authors: Abuyassin
authors: Hisham
authors: H
authors: Aljadhey
authors: Mohammed
authors: M
authors: Al-Sultan
authors: Sulaiman
authors: S
authors: Al-Rashed
authors: Mansour
authors: M
authors: Adam
authors: David W
authors: DW
authors: Bates
keywords: Discrepancies; Medication errors; Transitions
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